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BUILDING PERMIT F - Ti.- fl <br />Jurisdiction of 2 o <br />D <br />A <br />ADOlicant to como/ete numbered spaces only. 01 <br />JOBADDRESS <br />V r\ <br />W <br />LOT HO. <br />BLK <br />TRACT <br />(❑SEE ATTACHED SHEET) <br />OWNER MAIL ADDRESS <br />2 0 dui RS1451Wi <br />ZIP <br />�7 <br />PHONE <br />/411 <br />CONTRACTOR MAIL ADDRESS <br />3 <br />PHONE REGISTRATION NO. <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />4 <br />PHONE REGISTRATION NO. <br />ENGINEER MAIL ADDRESS <br />5 <br />PHONE REGISTRATION NO. <br />LENDER MAIL ADDRESS <br />6 <br />BRANCH <br />. <br />USE OF BUILDING <br />7 <br />/ <br />8 Class of work: ❑ NEW ❑ ADDITION O ALTERATION <br />REPAIR ❑ MOVE D REMOVE <br />9 Describe work:Milo <br />j <br />10 Valuation of work: a <br />PLAN CHECK FEE <br />PERMIT FEE ' <br />SPECIAL CONDITIO . ��y, � C <br />Type of <br />Const. <br />Occupancy <br />Group <br />Division <br />,Q y Rif r.� r 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 Yes ❑No <br />APPLICATION ACCEPTED BY <br />PLANS CHECKED BY <br />APPROVED FOR ISSUANCE BY. <br />No. of <br />Dwelling Units <br />OFFSTREET PARKING SPACES: <br />Covered Uncovered <br />N O T I C E <br />SEPARATE PERMITS ARE REQUIRED 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 />I 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) <br />- v <br />_ <br />IGNATURE OFCrWW 0FO--E BU DER) E) <br />oj�—/ /- C'/7 //LQ�4wI`tLT WHEN PROPERLY VALIDATED IIN THIS SPACE) THIS IS YOUR PERMIT <br />PLAN CHECK VALIDATION - CK. M:O. CASH PERMIT VAL ATION CK. M.O. CASH <br />9� <br />A-1 <br />