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<br /> Joe ADOR ESS
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<br /> LOT NO. ,eLk I T....CT OSEE ATTACHED SHEET)
<br /> LEG"L I 2C1 I -.... ,., ,
<br /> 1 DESC". /<t>J~~:f' /1./~~liJ 775 7 (
<br /> OWNER MAIL AOD'U::SS ZIP PHONE
<br />.... 2 Kdl.1I1!t1llli,) Loi7 X??(} ~ (,,;i::+/)r ..JUf I .,.- '/ ~i' 4/) ':'V-,
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<br /> CON T....C Tolf MAIL ADDRESS t PH ON E . REGISTRATION NO.
<br /> 3 Dr- V P r:S; S; /7;J:J /f r/i!Ti: 12 4'7,,'1-7 :l 77
<br /> ARCHITECT OR DESIGNER MAIL. ADDRESS PHONE. REGISTRATION NO.
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<br /> ENGINEE.R MAl L ADDR lESS PHONE. REGISTRATION NO.
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<br />;.1..' LENDER MAIL ADDRESS BRANCH
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<br />: 7 USE 0' BUILDING
<br /> 8 Class of work: DNEW o{DDITIDN D ALTERATION o REPAI R D MOVE D REMOVE
<br /> 9 Describe work: J 7Xi> ,....J... /'-1 k. 3</ :;;z..,...) it!." / ./ [0'7/1/ ,~r; E-~::- / <77/ 11/ ~ r-/t1IP1~
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<br /> Valuation of work: $ /7;B1'O I PERMIT FEE ,.--' . :::/"
<br /> 10 " Of'"
<br /> PLAN CHECK FEE 0
<br /> SPECIAL CONDITIONS: " Type of Occupancy
<br /> Const. l/( Group /,~- Division
<br /> Size of Bldg. No. of Max.
<br /> (Total) SQ. Ft, <I, -:~~ (~~ Stories I Occ. Load
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<br /> Fire ; Use Fire Sprinklers
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<br /> APPLICATION ACCEPTED BY APPROVEO FOR ISSUANCE BY Zone /~/ '.,,\ Required DYes DNo
<br /> PLANS CHECKEO BY. ;.., Zone /V'" - I
<br />'. f14 No, of OFFSTREET PARKING jPACES:
<br />'. Dwelling Units I Covered Uncovered
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<br /> NOTICE V ..; Special Approvals Required Received Not Required
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<br />~, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB. ZONING ..
<br />:b lNG, HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT.
<br />~_.', THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON.
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<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 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 fiVE AUTHORITY TO VIOLATE OR CANCEL THE
<br /> PROVISIONS 0 ANY OTHER STATE OR LOCAL LAW REGULATING
<br /> CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
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<br /> SIGNATURE. OF' CONTfIt"CTO,. OR .AUTHORIZED AGENT ID..nl
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<br /> SIGNATURE 0" OWNER OF' OWNER BUILDER} (DATE)
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<br />BUILDING PERMIT
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<br />PLAN CHECK VALIDATION
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<br />WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
<br />CK. M.O. CASH PERMIT VALIDATION CK.
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<br />M.O.
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<br />CASH
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<br />APPLICANT
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