Oakbend Addn-CS 940411Job
Address:
Lot: Block:
Contractor: ~o ;d
Description of Work to be Done
BUILDING PERMIT APPLICATION
Print or Type in a Clear, Legible Manner
Class of Work:
~,0. ~
~New r'lAddition
Phase or Section Number:
~.: ~1,4 - ~ -555 6,
1~3~'¢ ~/7- ~"-/7-7t?~,3
Phone ~:
~temtion ~ Rear ~ ~molifion
Area of Building in Square Feet
First Floor
Second Floor
NOTICE
This permit becomes null and void if work or construction authorized is not commenced
within 150 days, or construction on work is suspended or' abandoned for a p~rind of 150
days at any time after work is commenced.
I hereby certify that I have read and examined this application and know the same to be true
and correct. All provisions of laws and ordinances governing this type of work will be
complied with whether specified herein or not. The granting of a permit does not presume to
:ire authority to violate or cancel the provisions of any other federal, state or local law
regnl__ating consmia~n or the performance of construction.
L~b,,,~/O,~c~ o~
signature of Contractor or Authorized Agent Print Name
Electrical Contractor
Plumbing Contractor
Mechanical Contractor
BIR- 1 (2/g2)
Value of Work
to be Performed
GRAY AREA FOR OFFICE USE ONLY
0 ~0
Scale , I "-'ZO'
711
~£AL
CUL~'~~