Building Permit ApplicationBUILDING PERMIT APPLICATION
Print or Type in a Clear, Legible Manner
Job Address= ~ ~:$ ~_.tOl~O0$~ /O/-/.~ b~n~7'Od 7'~/9, ~9~9~9d[(,. 7~ '7,~'O/~ Date: F~'8 /7, Z~)~'
Lot: Block: Subdivision: Phase or Section Number:
Contractor: .~ bON ]~tqLl-tqlO4.~ COt~. Address: /08 3 ~[oi[~, COPPEr(_ Phone#: <[--iZ. t4(.2, i-}c~Z
Description of Work to be Done Class of Work: [] New [] Addition [] Alteration [] Repair [] Demolition
Area of Building in Square Feet
First Floor 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 suspended or abandoned for a period of 180 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
give authority to violate or cancel the provisions of any other federal, state or local law
regulating construction of the performance of construction.
Signature of Contract?r orguthorized Agent Print Name --
5
Electrical Contractor Plumbing Contr-actor Mechanical Contractor
Value of Work ~ff't~7
to be Performed .! OC;L9
GRAY AREA FOR OFFICE USE ONLY
Permit: Fee: Receiot Number:
Zoning District: Occupancy Classification:
Approved By: Date:
Comments:
FPMC - 1 (4/94)
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK