Gibbs Station 1-CN 930420Job Address: 5~4 ~)¢rl LA
BUILDING PERMIT APPLICATION
Print or Type in a Clear, Legible Manner
Date:
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Ix)t: I Block: ~-
~ontractor: '-}
Description of Work to be Done
Class of Work:
Address: y ~)
Address:
~Ad~tion
Phase or Section Number:
Phone #:
Alteration [] Repair [] Demolition
Area of Building in Square Feet
First Floor Garage_
S~.:ond Hoot
Other
NOTICE Permit Fee:
~his permit becomes null and void if work or construction authorized is not commenced
within 180 days, or construction on work is suspended or' abandoned for a period of 180 Zoning District:
days at any time after work is commenced.
Value of Work
to be Performed
1 hereby certif7 thai I have read and examined this application and know the same to be true
and correct. All provisions of laws and ordinances guveming thi~ 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 pmvisiom of any other federal, state or local law
regulating construction or the performance of construction.
Signature of Contractor or ~thorized Agent Print Nara~.)
Electrical Contractor Plumbing Contractor
Mechanical Contractor
GRAY AREA FOR OFFICE USE ONLY
Receipt Number:
Occupancy £ lassificaflon
Approved By: Date:
HOLD HARMLESS AGREEMENT
WHEREAS, THE OWNER OF LOT___~_, BLOCK ~'- , OF THE
(~D~SS), COPPE~, T~ (~ O~ER) ~DE~T~D ~
AC~O~EDGE ~T ~ FENCE EICH IS LO~TED ON ~IR PROPER~
ENCRO~S 0~0 T~ CI~ OF COPPE~ ' S D~I~GE ~;
~, ~ 0~ ~E~T~D ~ AC~O~EDGE ~T IN ~E
~p~ OR I~RO~S ~ ~QUI~D TO BE ~E TO ~ CI~ OF
COPPE~'S D~GE ~ EICH WO~ ~QUI~ ~MOV~ OF ~
FENCE IN O~ER TO EFFECT SUCH I~RO~E~S; ~D
~, ~ O~RS ~COGNIZE ~ A~O~EDGE ~T SUCH FENCE
W~ INSTAVJ~D DESPITE ~O~DGE OF T~ CI~'S D~I~GE ~EE~;
O~RS ~BY AGUE TO ~MO~ SUCH FENCE AT ~IR O~ COST ~
~ON ~Q~ST BY ~ CI~ OF COPPE~, ~ IF O~RS F~L TO ~MO~
~ FENCE ~ON ~Q~ST BY T~ CI~, ~N CI~ WI~ ~MO~ SUCH
FENCE ~D O~RS E~BY I~E~IFY ~D HOLD ~ CI~ ~ESS FROM
b~J. C~I~ OF D~GE TO ~ FENCE EICH ~ISE FROM ~ CITY'S
~MO~ OF SUCH FENCE ~I~ ~PAIRING, INSPECTING, I~ROVING OR IN
~ WAY SEEKING ACCESS TO ~ D~I~GE ~EE~. ~DITIO~rJ'Y,
O~RS AGUE TO ~I~SE ~ CI~ FOR ~O~LE COSTS INC~D IN
~MOVING T~ FENCE. ~ ~ ~
DATE . . (o~er)
]SURVEY PLA~j IiI
LOT I, BLOCK E, OF ClBB,.V STATION PHASE ONE. AN
ADDITION TO THE CITY OF COPPEL;.,, bALLA$ COUNTY~ TE.XA.~
/LOT 1 '---.,F~
/' "BLK. E ' -
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FORMBOARD
SURVEY
IgL~Y. 457.37
40.0' "~------""-**'
534 BEVERLY DRIVE