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• ~ 1 <br />_._ <br /> <br /> <br />r: <br />BUILDING PEKM1 1 <br />_ <br /> . <br />.lurisdictio;l of <br />pplicant to complete numbered spaces only. <br />/ <br />JOB ADDR ESS <br />/ <br />~ <br />G , '/Jfw'V/-H/ <br />LEGAL ~,T~(J J ~ p~ 7 ~ •LK TRACT (OgEE ATTACH EO SHEET) <br />1 DESCR. n i ~D / <br />oC I~~ <br />PHONE <br />MAIL ADDRESS <br />OWNER 21P <br />`~ <br /> <br />CONTRAC iOR MAIL ADDRESS PHONE REGISTRATIONN <br />3 <br />_ <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />PHONE <br />REGISTRATION NO. <br />4 <br />ENGINEER MAIL ADDRESS PHONE REGISTRATION NO. <br />5 <br />(ENDER MAIL ADDRESS BRANCH <br />6 <br />USE 0I B:1ILDING <br />7 ~. I <br />L <br />S Class of work: ^ NEW ^ ADDITION ^ ALTERATION ~y.R~AIR ^ MOVE ^ REMOVE <br />9 Describe work: <br />~ .. <br /> <br /> r <br />I <br />10 Valuation of work: $ PLAN CHECK FEE PERMIT FEE <br />SPE ONDITI NS: Type of Occupancy <br /> Const. Group Division <br />~,! •+-YL Size of Bldg. No. of Max. <br />NT C.. O ~~ <br />O f2 f2 (Total) Sq. Ft. Stories Oct. Load <br />n <br />~- ~ /'T~ GQ icJ~~ ~"~ Fire Use Fire Sprinklers <br />i <br />R <br />d ^ <br />^ <br />APPLICATION ACCEPTED BT. PLANS CHECKED BV N 8 <br />APP E OR i Zone Zone re <br />equ <br />yes <br />NO <br /> ~ OFFSTREET PARKING SPACES: <br /> 7 / /~~ <br />/ <br />3 <br />! No. of <br />d Uncovered <br /> !l <br />~.,~i <br />J Dwelling Vnits Covere <br />E <br />N ~ -~ ~ \ Special Approvals Required Received Not Required <br />i <br />PLUMB- <br />ARATE PERMITS ARE REQUIRED FOR ELECTRICAL ZONING <br />, <br />SEP <br />ING, HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT, <br /> THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- - <br /> TRUCTION AUTHORIZED IS NOT COMMENCED WITHIN f) FIRE DEPT. <br /> S <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 /> <br />MENCED OTHER (Specify) <br /> . <br />WORK IS COM <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 /> THE GRANTING OF A PERMIT DOES NOT <br />HEREIN OR NOT <br /> , <br />PRESUME TO ~IVE AUTHORITY TO VIOLATE OR CANCEL THE <br />PROVISIONS O ANV OTHER STATE OR LOCAL LAW REGULATING <br /> C ST RUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> <br /> SI NATURE Oi CON A TO UTHORIZED AGENT DATE) <br /> <br /> _.- ~~I nc Rl (DATE) <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH <br />ExHistT C <br />A-1 <br />