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<br />DATE OS- ~ /2. - () L-{ <br />PERMIT # D-{.() 1:133 <br /> <br /> <br />BillLDING <br />PERMIT APPLICATION <br /> <br />(V1A(1\1 sT' <br />OWNER CONTRACTOR/OTHER (DESCRIBE) <br /> <br />JOB ADDRESS <br /> <br />SUBDIVISION <br /> <br />LEGAL DESCRIPTION <br />LOT <br /> <br />BLOCK <br /> <br />PID# <br /> <br />ADDRESS PHONE~.Z."1')...1 <br />Au L Dltf\.AJ 21-(]. ~ 140 5 3. '" <br />CONTRACTOR L CENSE # <br />NAME ADDRESS PHONE # <br />CW~cJ() QOfV"S{v--k.~ 3{33;Jlc.G(f~+G'~- ~"-2'72-"j <br />ARCHITECTIDESIGNER/ENGINEER <br />NAME ADDRESS <br /> <br />PROPERTY OWNER <br /> <br />NAME <br /> <br />PHONE # <br /> <br />CLASS OF WORK: <br /> <br /> <br /> <br />REMODEL <br /> <br />DEMO <br /> <br />ADDITION <br /> <br />DESCRIBE WORK <br /> <br />12-'i. - {2Oo I- CZ f} 0 lI'Q R.ubb.v <br />VALUATION OF WORK: S J L" 2 () G <br /> <br />COMPLETION DATE 0 ~ ~ 6 ,- 0 L..( <br />ENERGY CODE USED FOR THIS PROJECT (RESIDENTIAL CONSTRUCTION) <br />ENERGY CODE OPTIONS: 0 CATEGORY I 0 2000 ENERGY CODE <br /> <br />SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, <br />VENTILATING OR AIR CONDITIONING. <br /> <br />THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION A UTHORIZED IS <br />NOT COMMENCED WITHIN 180 DA YS, OR IF CONSTRUCITON OR WORK IS SUSPENDED <br />OR ABANDONED FORA PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS <br />COMMENCED. <br /> <br />I HEREBY CERTIFY THAT I HA VE 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 <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR <br />LO~ m::7G CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br /> <br />6 ~'( 2 -OL.J <br /> <br />SIGNATURE OF CONTRACTOR DATE <br /> <br />SIGNATURE OF OWNER <br /> <br />DATE <br /> <br />BUILDING DEPARTMENT. PHONE (763)635-1060. FAX (763) 635-1090 <br /> <br />, .-.-----.-.--.. <br /> <br />OFFICE USE ONLY <br />ENGINEER FEE <br /> <br />PERMIT <br /> <br />SURCHARGE <br /> <br />SEWER <br /> <br />ATIORNEYFEE <br /> <br /> <br />LICENSE CHECK <br /> <br />PLAN CHECK <br /> <br />TOTAL <br /> <br />APPL RECD BY <br /> <br />APPROVED FOR <br />ISSUANCE BY <br /> <br />TYPE OF <br />CONSTRUCTION <br /> <br />OCCUPANCY <br />GROUP <br /> <br />DIVISION <br /> <br />SIZE OF BLDG <br />(TOTAL SQ FT) <br /> <br /># OF STORIES <br /> <br />MAX OCC LOAD <br /> <br />USE ZONE <br /> <br />FIRE <br />SPRINKLERS <br />REQUIRED <br />DYES <br />o NO <br /> <br />_.....mn___._.___._.__ <br />