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~ 1 <br />^1~^ ^ ^ w ^ s ^ w w ~.. w is s ^ <br />~' ~ V V <br />Jurisdiction of <br /> <br /> <br /> <br />pplicant io complete numbered spaces only. r~ ~'~~ ~ ' 2 <br /> <br />D <br />'" e <br /> <br />O <br />' <br />O <br />I <br />u <br />u <br /> JOD ADOR E53 <br /> <br />LEGAL <br />1 DESCR. LOT NO. <br />// ~ /r / ~ <br />/I/ DLM <br />// TRACT SEE ATTACNED SNEET) <br /> OWNER ~- MAIL ADDR E~S7S ~7 ZIP PHON/E/ ~) <br /> CONTRACTOR MAIL ADDRESS <br />3 5~~~• PNONE REGISTRATION NO. <br /> ARCNITECT OR DESIGNER MAIL ADDRESS <br />4 PHONE REGISTRATION NO. <br /> ENGINEER MAIL ADDRESS <br />5 -- PNDNE - REGISTRATION NO. <br />i <br />LENDER MAIL ADDRESS <br />DRANCN <br /> USE OF BUILDING (~ ~/1` <br />7 ~~/ ~ ~ / <br />` <br /> 8 Class of work <br />: NEW ^ ADDITION O ALTERATION G REPAIR O MOVE ~ REMOVE <br /> 9 Describe work: <br /> ~ hl~ -' C/ars v zcr S~~/~~-G <br /> ~ ~i hcw~«.~'3 ZS ~ - - - <br /> <br /> 10 Valuation of work: $ <br />PLAN CHECK FEE <br />PERMIT FEE <br /> SPECIAL CONDITIONS: <br />Type of <br />Occupancy <br /> Const. Group Division <br /> Size of Bldg. No. of Max. <br /> (Total) Sq. Ft. Stories Occ. Load <br /> Fire Use Fire Sprinklers <br /> APPLICATION ACCEPTED BT. PLANS CHECKED BY. APPROVED FOH ISSUANCE 8~. ZOne Zone Required ^yes ^No <br /> ~ No. of <br />Dwelling Units OFFSTREET PARKING SPACES: <br />Covered Uncovered <br /> NOTICE Special Approvals Required Received Not Required <br /> SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB- zoNING <br /> ING, HEATING, VENTILATING OR AIR CONDITIONING. <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- HEALTH DEPT. <br /> STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 6 FIRE DEPT. <br /> MONTHS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR <br />ABANDONED FOR A PERIOD bF 6 MONTHS AT ANY TIME AFTER SOIL REPORT <br /> WORK iS COMMj=NCED. OTHER (speclty- <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT - <br /> . <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 IVE AUTHORITY TO VIOLATE OR CANCEL THE <br /> PROVISIONS O ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION <br /> . <br /> <br /> TRACTOR AU TN ORIZED AGENT (DATE) <br />O <br />C <br />SIGNA TU <br />O N\ <br /> /) <br />//~~~ <br />/ <br />/ <br /> ~ , <br /> SIGNA URE OF OWNER IF OWNER DU IL OE R) (DATE) <br />WHEN PROPERLY VALIDATED IIN THIS SPACE) THIS IS YOUR PERMIT <br />LAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH <br />L~ l- ' ~ ~ y <br />