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<br /> RUIL®IIVG PERMIT <br /> <br /> Jurisdiction of <br />~ O <br />O <br />pp/icant to comp/eie numbered spaces on/y. <br />uoe ADDR~ <br />t/ ~ ~ ~ <br />O ' ~ <br />O Y <br /> <br />LCGAL <br />~OESCR. OTf(O. <br />~ ~1 <br />i Dr ' ~ SlK ~~ TRACT •~ (OICC ATTA CN [D 9NCE71 <br /> , <br />OWNER <br /> <br />Z S ~- rr1 c MAIL ADDRESS <br /> <br />~ F L~ <br /> <br />L~ <br />ZIP PNONC <br />S ~~~D ~'~7 <br />CONTRACTOR / C <br />3 ~ ~ (~ r MAIL ADDRESS PHONE REGISTRATION NO. <br />AR CNI TECT OR OESIONCR <br />4 ~~~ MAIL ADDRESS PHONE REGISTRATION NO. <br />ENGINEER <br />5 _ ~' MAIL ADDR[59 PNONC REGISTRATION NO. <br />LCNDER <br />6 ~_.. MAIL ADDRCSS !RANCH <br />USC OF aU1LDINC <br />7 ,,.~__ _ <br />8 Class of work: ^ NEW O ADDITION O ALTERATION EPAIR O MOVE ~ REMOVE <br />9 Describe work: ~ ~ P ~~ C.~ ~ Pd /,~ - f ~ ~ E X ~' S f~ /l O <br />~ •R om ~ ~~ ~._ <br />10 Valuation of work: $ ~ .. PLAN CHECK FEE PERMIT FEE <br />SPECIAL CONDITIONS: o ~~ <br />of <br />Occupancy <br />w ° onst. Group Division <br />-~ ~/ <br />~~_~[_ ~~ ~ ~ ~ . T Size of 81dg. No. of Max. <br />L E D (Total) Sq. Ft. stories Occ. Load <br /> Fire Use Fire S <br />rinklers <br />APPLICATION ACCEPTED BY PLANS CNE CKED 6Y. APPR D FOR I 'DANCE 6~' ZOne Zone p <br />Req UirGd ~VGS ~NO <br /> <br />Q ~ I S ~ S~ No. of <br />Dwelling Units OFFSTREET PARKING SPACES: <br />Covered ~ Uncovered <br />N A 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 <br />ABANDONED FOR A PERIOD OF 6 MONTHS AT ANY TIME AFTER SOIL• REPORT <br />WORK IS COMMENCED. orHER 15peclry) <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT <br />. <br />ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />HEREIN OR NOT, TIDE GRANTING OF A PERMIT GOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE <br />PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />ATURE O- CONTRACTOR OR AU TNOR <br />~ ~ <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 />ExHis~T F <br />A.I ' <br />