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t <br />• <br />• <br />•® <br />^~^ w w^.^w~ ~ ^w~ <br />1 <br />VV'~~~~VV <br /> <br /> <br /> <br />Jurisdiction of <br />(Applicant to complete numbered spaces only. ~`~'®1 " <br /> <br />f <br />s <br />o <br />^ <br /> <br />° <br />r <br />toe ADDR Lss <br />G, <br /> <br />LCDAL <br />~ DESCw. ,40T 11v ~ ~ ~ // ~ <br />/{/ r( T <br />~ ~ `D / wlx <br />f~ <br />/~/ TIIAET <br />~ ~ ~ . <br />(^7LL ATTACN[O SM[[T) <br />DWNtw MAIL ADDwE3w <br />`• 210 PNON[ <br /> <br />CON7wAC TOw MAIL ADDNE75 <br />3 ~ PNON[ REGISTRATIONN <br /> <br />, <br />AR CNIT[CT ON DLSIGN LA MAIL ADDR Eel <br />4 PNON[ REGISTRATION NO. <br /> <br />MAIL woDRESS <br />LMGIN[Lw <br />5 <br />PNON[ <br />REGISTRATION NO. <br />LEND[R MAIL ADDw[33 <br />6 eIIANCN <br />YS[ O- eLILDIN6 T <br />7 <br />8 Class of work: ^ NEW ^ ADDITION ^ ALTERATION ~j1-R'1 PAIR ^ MOVE ^ REMOVE <br />9 Describe work: <br /> <br /> r <br /> <br />10 Valuation of work: $ PLAN CHECK FEE PERMIT FEE <br />SPE ONDITI NS: Type of Occupancy <br />~ Const. Group Division <br />•Yr1. Size o} EIId9• Na. of Max. <br />C ~ _ <br />Q /UT (Total) Sq. Ft. Stories Occ. Load <br />/ <br />/(J ~'T'L Lo k)ti "'~ Fire Use Fire Sprinklers <br />APPLICATION ACCEPTED er. oLAnS CNECICED ev: APP E ORI uAN a Zone Zone Required ^Ves ^NO <br /> 7 ~~ ~ NQ of <br />Dwelling Units OFFSTREET PARKING SPACES: <br />Covered Uncovered <br />• 'NOTICE Special Approvals Required Received Not Required <br />SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB- zoNING <br />ING, 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 G <br />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 <br />OTHER (Specify) <br />. <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO EIE 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 N,OT, THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO IVE AUTHORITY TO VIOLATE OR CANCEL THE <br />PROVISIONS O~ANV OTHER STATE OR LOCAL LAW REGULATING <br />C STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> <br />SI NATUw[ OI CON A TO UTNOwlttO A6[NT OAT[I <br /> <br />r nwr[w eu IL D[wl ~ OAT[) , <br />WHEN PROPERLY VALIDATED IIN THIS SPACE) THIS IS YOUR PERMIT <br />PLAN CHECK VALIDATION cK. M.O. CASH PERMIT VALIDATION cK. M.O.• ,CASH <br />L-XHtB~T C <br />A., <br />