Laserfiche WebLink
• • 1 <br /> <br />BUILDING <br /> <br />Jurisdiction of <br /> <br /> <br />plicant to complete numbered spaces only. PERMIT <br /> <br /> <br />- ~ <br />i <br />'" a <br /> <br /> <br />o <br />' <br />D <br /> oe AooR Ess <br />~ d ,~ o . ,~ `~ ` <br />-~ <br /> LEGAL <br />1 DESCR. ~~~~' ~ +~n~! f ~ <br />~ / , BLK ~~ TRACT ~ (^SEE ATTACHED SHEET) <br /> OWNER MAIL ADDRESS 21P PHONE <br /> CONTRACTOR L l C MAIL ADDRESS <br />3 ~ ,~ ~ I PHONE REGISTRATION NO. <br /> ARCHITECT OR DESIGNER MAIL ADDRESS <br />4 ~~_ PHONE REGISTRATION NO. <br /> ENGINEER MAIL ADDRESS <br />5 _ -- PHONE REGISTRATION NO. <br /> LENDER MAIL ADDRESS <br />6 .,~~ BRANCH <br /> USE OF BUILDING <br />7 .~---__ <br /> 8 Class of work: ^ NEW ^ ADDITION ^ ALTERATION EPAIR ^ MOVE ^ REMOVE <br /> 9 Describe work: ~ ~ ~ ~ ~ C ~ ~~ R -t' ~ ~ E ~/ ~r S f-% /~ <br /> S ~~ <br /> ~- R- G ~' ~- R D ~l- L~ c-.z~ <br /> <br /> 10 Valuation of work: $ / , <br />~V PLAN CHECK FEE PERMIT FEE <br /> SPECIAL CONDITIONS: <br />~ /~,Q- <br />of <br />Occupancy <br /> w ~° onst. Group Division <br /> ~~~~n o C~1\ ~ S ~ ~ T Size of Bltlg. No. of Max. <br /> D (Total) Sq. Ft. Stories Occ. Load <br /> Fire Use Fire Sprinklers <br /> APPLICATION ACCEPTED 8T PLANS CHECKED BV APPR D FOR I 'DANCE By ZOne Zone Required ^Ves ^NO <br /> <br />O ~ 1 S'~ 8~ No. of <br />DweUin9 Units OFFSTREET PARKING SPACES: <br />Covered Uncovered <br /> N O T I C E ~ 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 OF 6 MONTHS AT ANY TIME AFTER SOIL REPORT <br /> WORK IS COMMENCED. OTHER (specify) <br /> 1 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 N~nOT, TtiE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO <br />IVE AUTHORITY TO VIOLATE OR CANCEL THE <br /> y <br />PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION <br /> . <br /> <br /> IGNATURE Oi CONTRACTOR OR AUTHORIZED AGENT (DATE) <br /> <br /> I qTU RE OF OWNER IF OWNER RUI ) (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 />ExHEBIT F <br />A-1 <br />