Riverchase (4)-CN 941005HOLD HARmLeSS A~.M~NT
WH~F,A~, T}I~ OWNERS b'NDERSTAND AND AC~0~EDGE T~T
0~ ~BY AGUE TO ~ ~UCH F~N~= AT
~ C~I~ OF D~ TO ~ FENC~ ~ICE ~ISE FROM T~ CITY'S
~ WAT SEEKING ACCESS TO T~ D~%~ ~R'J'.
O~RS AG~ TO ~S~ T~ CIT~ FOR ~ON~L~
~MOVIN~ ~ PENCE,
( ow'~e I' i -
BUILDING PERMIT APPLICATION
Lot: Block:
Print or Type in a Clear, Lg~ib~anner
Phase or Se~tlon Number:
Phone #:
Address:
Phone #:
Description of Work to be Done Class of Work:
[~New I-]Addition [] Alteration [] Repair
[] Demolition
Area of Building in Square Feet
First Floor
Second Floor
Garage
Other
NOTICE
This 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
days at any time a~er 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 ordnances governing this type of work will be
complied with whether ipecified herein or not. The grantin~ of I permit does not presume to
give authority to violate or cancel the p~ovisions of any other federal, s~ate or local law
regulating construction or the pm-formance of construction.
/ ign -of Contractofror Authorized Agent Print Name
Value of Work
to t,o Pe forme, t
GRAY AREA FOR OFFICE USE ONLY
OccupanCy Classification:
e:
I
OJ~AP-T ~
~:~400'~
l~ll BAFZP,.IbI~TOI't PP,.IVt~
PLOT Pl.-AH SOA~ ~20'O"
FORM BOARD
SURVEy REQ~