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DATE <br />PERMIT # 0 C-)-D l �� <br />BUILDING <br />PERMIT APPLICATION OFFICE USE ONLY <br />JOB ADDRESS C-) "�.� f�]_, I'/ l J i � � „ E � � � � � � � <br />I <br />}NERl <br />ENGINEER FEE <br />THE ,APPLICANT IS: OWNER ❑ CONTRACTOR/OTHER (DESCRIBE) <br />PERMIT <br />LEGAL DESCRIPTION y <br /># <br />SURCHARGE <br />SUBDIVISION LOT BLOCK PID <br />SEWER <br />PROPERTY OWNER NAME ADDRESS PHONE At <br />ATTORNEY FEE <br />Vt7 v 1c vtgw <br />CONTRACTOR LICENSE # <br />LICENSE CHECK <br />NAME ADDRESS PH[O�NE # <br />f p, <br />J Y 1 � � <br />Q �+� v ' V b C �4 } '� t'] 2- <br />PLAN CHECK <br />ARCHITECT/DESIGNER/ENGINEER <br />NAME ADDRESS PHONE # <br />TOTAL <br />CLASS OF WORK: NEW ADDITION REPAIR OREMODEL DEMO <br />APPIt8j�� <br />APPROVED FOR <br />DESCRIBE WORK �' jfr (,(� <br />`1 <br />V <br />S <br />X t E l"7 � I ] <br />ISSUANCE BY <br />VALUATION OF WORK: S <br />TYPE OF <br />CONSTRUCTION <br />COMPLETION DATE <br />ENERGY CODE USED FOR THIS PROJECT (RESIDENTIAL CONSTRUCTION) <br />OCCUPANCY <br />ENERGY CODE OPTIONS: ® CATEGORY I Ej 2000 ENERGY CODE <br />GROUP <br />SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, REAP NG, <br />DIVISION <br />VENTILATING OR AIR CONDITIONING. <br />THIS PERMIT BECOMES NULL AAD VOID IF WORK OR CONSTRUCTIONAUTHORIZED IS <br />SIZE OF BLDG <br />NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTR UCITON OR WORK IS SUSPENDED <br />(TOTAL S+Q 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 APPLICATIONAND KNOW <br />THE SAME TO BE TR UE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED <br />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 />LOCAL LAWRESULATING CONSTRU TI(1NOR THE PERFORMANCE OF CONSTRUCTtOl1' <br />USE ZONE <br />C�� A,�,�� \J — <br />FIRE <br />SPRINKLERS <br />NKLERS <br />SIGNAT OF CO TRACTOR DATE <br />Y �' - � <br />L] REQUIRED <br />NO <br />SIGNATURE OF OWNER DATE <br />BUILDING &,ZONING DEPARTMENT . PHONE (763) 441-4900 9 FAX (763) 441-7425 <br />