Laserfiche WebLink
• <br />.~ ~ <br />~ <br /> <br />• BUILDING r, <br />~ERIVIIT <br /> <br />Jurisdiction of ~ a <br />~ pplicani io complete numbered spaces only. <br /> <br />_ boa ADDR ESS <br />l S 111, $ sir . ~~ ~~f~- ..._ .._..-- ..._. -. _. <br />-- -... _ ._•__.__. ....-. <br />__. <br />.--.- <br />-, <br /> <br />LEGAL <br />DESCR. LOT NO. aLR TRACT <br />,,: i1,,-~~%G }'Si' ~SC[ATTACNCD SMECT) <br />I <br />~ <br />i OWN(a~ , MAIL ADDRCaa <br />~ 1'S~ ~ ^-' .r~1: ~r1 <br />//~J~ 21P E <br /> <br />I <br />/ ^/ ./v•- / / rt~NON _.- __._ I __-.,_ <br />- <br />~'_ <br />_ 1 <br /> CONTRACTOR MAII ADDRC35 <br />~ -- PNONC REGISTRATION NO. <br /> s ~ <br />T~ ~ ... ----,--- - - --• <br /> AR CNI TCCT OR OESI6N [R ~-'-• MAIL ADDR [53 PHONE REGISTRATION NO. ~ • <br /> 4 ~ ~ I <br /> EN 6IN EER MAIL AooR ESS ~-_--• -"-" PNON[ •'~ -~-' REGISTRATION NO. I i <br /> <br />r <br /> <br />I <br /> <br />LENOCR MAIL ADDRESS <br /> <br />~ aRANCN <br />.... _. <br />._ <br /> 6 .. • . <br />i • a!. I ~ 1 <br /> . ... .. -_....-._....-__ <br />.-. .-_-- ._._ ._. ._ __..-.-_ .. -..-_._-~-_.-...~..~.___-__~.__.-__-__ <br /> USL Of aY1LDIN6 ~ , <br />• + <br /> I .. •:.. . <br />• 'I li Class of work: : D NEW ^ ADDITION ^ ALTERATION D REPAI R ^ MOVE D REMOVE j • <br />' ; 9 Describe work: " G <br /> <br /> <br /> <br /> <br /> 70 Valuation of work: $ "'• ~• • - '• <br />~' ~ •• ' <br /> ~ ' ' PLAN CHECK FEE PERMIT FEE ' <br />' SPECIAL CONDI IONS: '• Type or • • Occupancy - .- .1 <br /> Const. Group ~ Division ' <br /> ' - ~ `- - -'- ~ ~~` ~ Size o1 Bldg. - No. of Max. - i:.• • • <br /> ' ~ ,.... ~ - ~ (Total) Sq. Ft. ~ Stories Occ. Load rq:y;': <br /> '~ •' Fire -- Use Fire Sprinklers <br />, <br />,~~; APPLICATION ACCE PTEO BY. PLANS CtIE CKED eY: APPROVED FOR ISSUANCE eY. ZOne ZOrle ~ Required ^Yes <br />'M DNO <br /> ?" ~ ~ <br />: : ` • No <br />of OFFSTREET PARKING SPACES: <br />. <br />1..5 <br />. ~, <br /> . <br />• - '• - - ' ' •• . <br />Dwelling Untts Covered . ti, •.~ <br />R <br />Uncovered .' .r'•1`' ~d' <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 s 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 (Speclry) - ' <br /> 1 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 l>IVE AUTHORITY TO VIOLATE OR CANCEL THE <br /> PROVISIONS Off' ANY OTHER STATE OR LOCAL LAW REGULATING <br /> CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />SIONATYRC Of CON TRAC TON O A TNORI2ED AGCNT IOATEI <br />51 NAT R O OWNER Ir OWNER eU ILD IOATCI <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 />EXHIBIT Ci` <br />A•1 <br />