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<br />..~ <br />...;, <br /> <br />I <br /> <br />..--- <br /> <br />>< <br /> <br />,~ . . ., ~ <br /> ;;; 0 <br /> ;< .. <br /> Jurisdiction of '" . <br /> " 0 <br /> 0 <br />~) " <br /> '" <br /> Applicant to complete numbered spaces only. .. <br /> .. <br /> JOB ADO" [55 <br />- /0 ~ o ( .J11 t.../ l/ A e'"IV f <br /> LOT NO. lOCK I TAeli f- f l-e . (OSEE ATTACHED SHEET) <br />--1 1 ~~~~~. 206 3 ,'5 rOUA./tl Es let.;.,.s <br /> OWN Eft MAIL ADDRESS ZIP PHONE <br />.>r 2 -rHOMA$$f"P. 1'/(/. / M. <br /> CON TRAC TOR MAIL ADDRESS PHON E: REGISTRATION NO. <br /> 3 <br /> ARCHITECT OR DESIGNER MAIL ADORE-55 PHON E REGISTRA nON NO. <br /> 4 <br /> ENGINEER MAIL ADDRESS PHONE. REGISTRATION NO. <br /> 5 <br /> LE.NDER MAIL ADDRESS BRANCH <br /> 6 - .' <br /> USE 0' eUILDING f/tv/ <br /> 7 Ke<))~V1 <br /> 8 Class of work: ~ NEW o ADDITION o ALTERATION o REPAI R o MOVE D REMOVE - <br /> 9 Describe work: ( ti oU < f rt ~ I- '~ A./ C-f. Ct .IV f' tV fit' u-( e , <br />~ 10 Valuation of work: $ 3~ tJVO r I PERMIT FEE <br /> !'I~' PLAN CHECK FEE <br /> SPECIAL QUNDITIONS . t'\J Ii i ~ype 1- I (j t Occupancy <br /> I ) , f} J I IffW co~it. I..,. Group Division <br /> / /eJ-/-11 c;r a /}c- ) /10 f I ~ r l's-rtl .... t ' <br /> II of BI>3g. No. of Max. <br /> f--- - , (Total) S~. Ft. <br /> I J J Stories Occ. Load <br /> /PlY' ~ I r <-:r h~ ~~ f/-e. 62-J{ (f' me Il i . Fire Use Fire Sprinklers <br /> APPLICAtiON ACCEPTEO BY PLANS CHECKED BY APPROVE:.O FOR ISSUANCE BY Zone Zone Required DYes DNo <br /> No. of OFFSTREET PARKING SPACES: <br /> Dwelling Units Covered I Uncovered <br /> NOTICE Special Approvals Required Received Not Required <br /> SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB- ZONING <br /> lNG, HEATING, VENTiLATING OR AIR CONDITIONING. HEALTH DEPT. <br /> THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- <br /> STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 6 FIRE DEPT. <br /> MONTHS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR SOIL REPORT <br /> ABANDONED FOR A PERIOD OF 6 MONTHS AT ANY TIME AFTER <br /> WORK is COMMENCED. OTHER (Specify) <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 ANO 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 /> .. <br /> .:$IGNAT....RE OF CONTRACTO~ O~ AtJh;ORIZEO AGENT IDA TEJ <br /> PauJ /77. d h>>!a.vu.f <br /> 31c,'~Ar..;Hl (IF OWNfR IF OW"lf.R BUILDER) (DA TEl <br /> <br />BUILDING PERMIT <br /> <br />~ <br /> <br />x <br /> <br />~ <br /> <br />PLAN CHECK VALIDATION <br /> <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />CK. M.O. CASH PERMIT VALIDATION CK. <br /> <br />M.O. <br /> <br />CASH <br /> <br />A.' <br /> <br />:t: :'::. -~ <br /> <br />.. ...... ..... ......r.~. . <br />... ~. " ....... .......~;r-: "":"""--' <br />. ..'., "C''':!,' .;~,.~ <br />