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DATE OT — / 2- - C LI <br /> • <br /> PERMIT # C/ LO 1 <br /> BUILDING <br /> PERMIT APPLICATION OFFICE USE ONLY <br /> JOB ADDRESS ( ^ ' S ENGINEER FEE <br /> A) <br /> THE APPLICANT IS: ❑ OWNER rig CONTRACTOR/OTHER(DESCRIBE) PERMIT <br /> LEGAL DESCRIPTION SURCHARGE <br /> SUBDIVISION LOT BLOCK PID# <br /> SEWER <br /> PROPERTY OWNER NAME ADDRESS PHONE#6 9-1 ATTORNEY FEE <br /> (p Au L p VAt f2q2 0_,00 5 L 3 3 CONTRACTOR L ENSE# LICENSE CHECK <br /> NAME I ADDRESS <br /> 9 / PHONE# <br /> l� eda k, 0.Gnl 1"fi.f .c.x, J f 3 '3A)1 co(te4" 64 Z -5 ?c,- 2-q! Z PLAN CHECK <br /> ARCHITECT/DESIGNER/ENGINEER <br /> NAME ADDRESS PHONE# TOTAL <br /> • CLASS OF WORK: ❑NEW ❑ADDITION I =REPAIR ❑REMODEL ❑ DEMO APPL RECD BY <br /> DESCRIBE WORK APPROVED FOR <br /> _ Q db r 0 0 vrt Qv+ -(� ISSUANCE BY <br /> VALUATION OF WORK: $ 12 , 2 6 V b TYPE OF <br /> y ) r CONSTRUCTION I <br /> J <br /> COMPLETION DATE 0c ^ 0 —( <br /> ENERGY CODE USED FOR THIS PROJECT(RESIDENTIAL CONSTRUCTION) OCCUPANCY <br /> ENERGY CODE OPTIONS: ❑CATEGORY 1 ❑ 2000 ENERGY CODE GROUP <br /> SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING,HEATING, DIVISION <br /> VENTILATING OR AIR CONDITIONING. <br /> THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS SIZE OF BLDG <br /> NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTR UCITON OR WORK IS SUSPENDED (TOTAL SQ FT) <br /> OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS <br /> COMMENCED. <br /> #OF STORIES <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW <br /> THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANES <br /> GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED MAX OCC LOAD <br /> HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br /> LOC L, SULA I NG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. USE ZONE <br /> ‘ * 0 /*„ 6 r-e 2. -134-) <br /> SIGNATURE OF CONTRACTOR DATE FIRE <br /> • SPRINKLERS <br /> REQUIRED <br /> DATE ❑ YES <br /> SIGNATURE OF OWNER ❑ NO <br /> BUILDING DEPARTMENT•PHONE(763)635-1060 •FAX(763) 635-1090 <br />