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<br />1 <br /> <br /> " 0 <br /> ~ <br /> z .. <br /> Jurisdiction of '" . <br /> :a 0 <br /> 0 <br /> :a <br />Applicant to complete numbered spaces only. '" <br /> .. <br /> .. <br /> Joe ADOI' [55 <br /> 2\61 SV\. W' ~eu. L y,\ <br /> I COT NO. --J I"CK I TR AC T J&€EE ATTACHED SHEETI <br /> l.EGAL <br />lDESCR. . 1'. t ~ 1__ <br />20t.:!o ',\\Ot". , G.eu: ~ MAIL ACDRESS ZIP tt- ....,. -, 'PHONY ~ i,~ 31 <br />L j~ <(: C(Clct 4 SpeV\..cev- 103 'T'lS'1( <br />I . <br /> CO~AC TOR Qa,u.) ki",-s MAIL ADDRESS , PHONE REGISTRATION NO. <br />3 ~O..,...., t; L.J. bU\\lj,jt- 5.d...~ U- ~ Cc Ioo.te. <br /> ARCHITECT OR DESIGNER MAl L. ADORE.SS PHON It REGISTRATION NO. <br />4 <br /> ENGINEER MAIL. ADDRESS PHONE REGISTRATION NO. <br />5 <br /> LEN 0 ER MAIl. ADDRESS BRAN Clot <br />6 <br /> uSE 0' BUILDING <br />7 'i'eS ~ c\e "'- c e- <br />8 Class of work: ~NEW o ADDITION o ALTERATION o REPAIR o MOVE o REMOVE <br />9 Describe work: 1) '.... ~ \J e. \..U ~ ~ h. eJ....U \--.0 V"I'...-e-. - .q \rQ.... '\J <2-.\ <br /> -...J <....J <br /> Disa / .Lved <br /> go // ./ <br /> //7 <br />10 Valuation of work: $ \000- r :71123/// I PERMIT FEE <br /> PLAN CHEC FEE <br />SPECIAL CONDITIONS z,Qi-! ~.....<"" c/f'4,AA___'" I )C/ I Type of Occupancy <br />t-(!..,oJ .~. tJ,.. .../",,,,,-1 Il~~ ./ /'I!)f rk '-.... IA~'.'G"'..A , Const. Group Division <br /> , r / / <br />~~~ Size of Bldg. No. of Max, <br /> (Total) Sq. Ft. Stories Occ. Load <br /> Fire Use Fire Sprinklers <br />APPLICATION ACCEPTE.D BY PLA.NS CHECKED BY APPROV~D FOR ISSUANCE BY Zone Zone Required DYes oNo <br /> No. of OFFSTREET PARKING SPACES: <br /> Dwelling Units Covered I Uncovered <br /> NOTICE Special Approvals Required Received Not Required <br /> SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB. ZON I NG <br /> lNG, HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT. <br /> THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON. <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 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 />G!;~CONC~R:(C* AGENT (CA TE) <br /> 51 CON" TU FIE Of" OWNER If" OWNE.R aUILOER) (D....TEl <br /> <br />BUILDING PERMIT <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 />A.l <br />