Oakbend Addn-CN 921230HOLD HAJ~ ~'~E A~'~
~ ~m~m~,~.~g~ ~ :t~ Um~.s, DRAINAGE EASEMENT
~ ~ .. , ~~= FENCE
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DATE
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Print or Type in a Clea/, Legible Manner
Job Addre~:
Owner:
Contractor:
Description of Work to be Done
Address:
Phone #:
Class of Work: [] New []Addition ,~iteration [] Repair l-]Demolition
Area of Building in Square Feet
First Floor Garage.
Second Floor Other
NOTICE
Dfi~ permit becomes null and void if work or coastraction authorized is not commenced
within 180 days, or construction on work is suspcnded or abandoned for a period of 180
days at any lirac after work is commenced.
Vulue of Work
to be Performed
GRAY AREA FOR OF~CE USE ONLY
Electrical Conh-actor Plumbing Contractor