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~~ c ~ CITY OF LA PORTE •.. <br />PERM_TT d?PLICATION FORM <br />BUILDIYG ~_~ MECSANIC3L *ELECTRICAL _`C *PLUi:RING ~_ <br />* (S£E BAC~C OF FORM) <br />PROJECT ADDRESS : /~D G GL~W~~ LOT R : GI <br /> <br />SUBDIVISION: _ C_O N'~ ii <br />~ ~.~' ~~o Nl L S'I .t" ~S ~ BLOC~C ~ ~ ~ - <br /> <br />OWNER'S NAME : _ ~ ~ ~ R-y . T /o ~t.~c L S 'PHONE R y Z~'--76 7 <br /> <br />ADDRESS : ,~ ~~~ W Nl ~ I w ~ I!~ ~O iw ~ TyC ~ 7 7 ~ Z-~ . <br />STREc T CITY Z_Tp <br />CONTRACTOR: ~ ~ pH; ~ ~ <br />ADDRESS: <br />STREET CITY ~~~ ZIp <br />SNGIYEER : ~ T ~ S W (-I f T~ . <br />DESIGNER: /~OR~S D3'I GNC:2. :~ <br />3UILDING USG : ko +~' r.= N~S° SQ . F OOTAGc : ~ r~,> y ~~ R ~STORFES : I <br />VALUATION : 3lD D 0 ~"~ "'DESCR_TBE i~ORK : N~ c/ ~-I ~ v 5 ~, <br />--F OR CITY USc^. ONLY-- <br />OCCUP TYPE FLOOD ZONE CLASS TrTORK SQ. FT. <br />CONST TYPE USE ZONE R STORIES PKG REQ <br />COMM. BLDG. PLAiYS~ ONLY - FIRE MARSHAL APPROVAL: DATE: <br />CHEC~CED/APPROVED FOR ISSUANCc. •BY:~ pAi+E; 5 <br />SPy'CiAL• CONDITIONS: Sr~ h ~ ._ __ .p ~~e~ ~O! ~.. ~:..,~., ~ . r: ['~ G1-.~,.~~' <br /> <br />... ... ... _ - .~y S <br />PERMIT N0. ~ ~- PERMIT FEE S (ATTACH TO ACTUAL PERMIT) <br />REV . 3 -9 2 .._ <br />... ~ --. ~~'H1Bi'~' ~ <br />A:PE'RMITAP.ORG/DEPT. FORMS <br />