Park Place-CN 920630HOLD I"IAR~? ~:~; AG~'f
BUILDING PERMIT APPLICATION
Print or Type in a Clear, Legible Manner
Lot: lock Subdivision:
Description of Work to be Done Class or Work: /~New r-lAdditlon [] Alteration [] Repair [] Demolition
Area of Building in Square Feet
First Hoot Garage.
Second Floor Other
NOTICE
This permit becomes null and void if work or construction authorized is not commenced
within 180 days, or construction on work is suapended or abandoned for a period of 180
days at ally time after work is commenced.
1 hereby certify that I have read and examined this application and know the same to be true
and correcl. 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 pr~ume to
give authority to violate or cancel the provisiona of any other federal, slate or local law
J2Sigodu~ Of C(Sntrscto(o~ A~thorized Agent Print Name
~ Plumbing Contractor Mechanical Contractor
Value of Work
,o be
GRAY AREAFOR OF~CE USE ONLY