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<br />1 <br /> <br />BUILDING PERMIT <br /> <br />~ <br />2 <br />. <br />, <br /> <br />Jurisdiction of <br /> <br />Applicant to complete numbered spaces only. <br /> <br /> <br />f 0 A V (.. 'I If 1\ <br /> <br />...~ <br /> <br />H"C './_ . .' _ . _.,. _.. _. _" _ <br /> <br />/J./~"o.f}: O:1J"'....'i r;r7; <br /> <br />..-'05(.[: A T1~-C~~.D ~ ."'(1 T) <br /> <br />1 ~~:~~. <br /> <br />o"""t" <br /> <br />....AIL AOO"C...- <br /> <br />%I~ <br /> <br />"...0..[ <br /> <br />2 <br /> <br />o~ c;, l, <br /> <br />.' ~.:}...: <br /> <br />i-;j:. <br /> <br />.......IL .&.OO"t". . <br /> <br />.tofc....t <br /> <br />REGISTP.A nON NO. <br /> <br />3 <. '-/ <br /> <br />."C.M'TtC.T 011I DtS.,..l" <br /> <br />MAIL "'OD"l'. <br /> <br />~1ol0"'t. <br /> <br />REGlSTRAnON NO. <br /> <br />4 <br /> <br />till' IN t.t." <br /> <br />....... L AOOIII (oS I <br /> <br />lItlolO...t" <br /> <br />. REGISTP.AnON NO. <br /> <br />5 <br /> <br />L tHec" <br /> <br />.......1\,. "'OO"tIS <br /> <br />. . "... Ill' eM <br /> <br />6 <br /> <br />use 0" aVILDltrre' <br /> <br />7 <br /> <br /> <br />""l ., -: -t 51/? 1''''--< e, <br /> <br />8 Class 01 work: <br /> <br />~NEW <br /> <br />o ADDITION <br /> <br />o ALTERATION <br /> <br />C REPAI R <br /> <br />o MOVE <br /> <br />o REMOVE <br /> <br />9 <br /> <br />Describe work: <br /> <br />frc..c-T <br /> <br />~ <br /> <br />'-IOlf X (0 If >1-0'- <br /> <br />-c.. bv ,ltI-.:. <br /> <br />10 Valuation of work: S <br /> <br />> <br /> <br />OcJ(7 <br /> <br />Cl(/ <br />- <br /> <br />PLAN CHECK FEE <br /> <br />I PE RMIT FEE <br /> <br />/9 <br /> <br />00 <br />- <br /> <br /> <br />Type of <br />Const. <br /> <br />- 4c c.. <br /> <br />Division <br /> <br />AP9lIC"'1"O"" .CCEPlED BY "I....NSC...ECKEO ev <br /> <br />/ <br />I Ule () <br />Zone /~ '- <br /> <br />Max. <br />Oec. Load <br /> <br /> <br />Fire 50rinklers <br />Reou;red DYes [ <br /> <br />OFFSTREET PARKING SPACES: <br />I Uncovered <br />I <br /> <br />NOTICE Z~((/ <br />SEPARATE PERMITS ARE REQUIRED FOR ELEC I CAL, I'LU~B. <br />lNG, HEATING, VENTILATING OR AIR CONDlTlONI G. <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON. <br />STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 6 <br />MONTHS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR <br />ABANDONED FOR A PERIOD OF 6 MONTHS AT ANY TIME AFTER <br />WORK is COMMENCED. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />P.PPLICP.TION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />P.LL 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 OOES NOT <br />PJ:<ESUME 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 />Rec:eived <br /> <br />Not Requir <br /> <br />ZONING <br />HEALTH DEPT. <br />FIRE DEPT. <br />SOIL REPORT <br />OTHER (Spetlfyl <br /> <br /> <br />10"'" t I <br /> <br />1t''''iC) <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 />/43 / <br /> <br />L" <br />