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ILDING PERMIT• o <br />=m <br />Jurisdiction of D O <br />D <br />Applicant to complete numbered spaces only. a <br />Joe ADO" ESS <br />(A <br />d <br />LfGAL <br />1 DESCR. <br />LOT 110, <br />- <br />� n2�- � <br />BLK <br />n <br />1��� <br />TRACT <br />(❑SEE ATTACHED SHEET) <br />(// <br />OWNER MAIL ADDRESS ZIP PHONE <br />z <br />fpf ,f ) C z, SilfSs/ /. P ? <br />3 CONTRACTOR MAIL ADDRESS PHONE REGISTRATION NO. <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE REGISTRATION NO. <br />5 ENGINEER MAIL ADDRESS PHONE REGISTRATION NO. <br />LENDER MAIL ADDRESS BRANCH <br />6 <br />uf.E OF BUILDING <br />7 - <br />8 Class of work: ❑ NEW ❑ ADDITION ElALTERATION REPAIR ❑MOVE ❑REMOVE <br />9 Describe work: e <br />` <br />•6.1 �..V� <br />VZ✓W 1Y ` Y. <br />i A <br />10 Valuation of work: C�.vv�' (.✓! <br />PLAN CHECK FEE <br />PERMIT FEE <br />SPECIAL C0 DITIO �$`�., / - C <br />Type of <br />Const. <br />Occupancy <br />Group <br />Division <br />'.' aC S 01 �L <br />'r <br />A'-A/ • <br />Size of Bldg. <br />(Total) Sq. Ft. <br />No. of <br />Stories <br />Max. <br />Occ. Load <br />Fire <br />Zone <br />Use <br />Zone <br />Fire Sprinklers <br />Required Oyes ❑No <br />APPLICATION ACCEPTED BY <br />PLANS CHECKED By <br />APPROVED FOR ISSUANCE BY <br />L / , <br />No. of <br />Dwelling Units <br />OFFSTREET PARKING SPACES: <br />Covered Uncovered <br />N 0 T I C E <br />SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMB- <br />ING. HEATING. VENTILATING OR AIR CONDITIONING. <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- <br />STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 6 <br />MONTHS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR <br />ABANDONED FOR A PERIOD OF 1 YEAR AT ANY TIME AFTER <br />WORK IS COMMENCED. <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />.APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE <br />PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />Special Approvals <br />Required <br />Received <br />Not Required <br />ZONING <br />HEALTH DEPT. <br />FIRE DEPT. <br />SOIL REPORT <br />OTHER (Specify) <br />SIGNATI✓,REE OF CONTRACTOROR•UTNORIIED AGENT iI(J (OATEI <br />% Cam, <br />•� <br />IG14TURE OF O+.N IF OnNFP 8t: DER) EY7 ) <br />� <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />PLAN CHECK VALIDATION - CK. M.O. CASH PERMIT VAL ATION CK. M.O. CASH <br />A-1 <br />