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Permit No. C 977 OF HOUNDS W91E 1Mli <br />o U L OWR <br />Applicant to complete numbered spaces only. <br />SITE ADDRESS <br />oaf2d5 Vidt.—O &/2 792 —4&m <br />Z <br />D <br />OWNER MAILADDRESS <br />2M <br />,, �ci /1 r / (� f rra <br />ZIP PHONE <br />M <br />:0 <br />v <br />p <br />N <br />CONTRACTOR J{ MAILADDRESS <br />ZIP PHONE <br />3 <br />ARCHI CT/DESIGNER/ENGINEER MAILADDRESS <br />ZIP PHONE <br />USE OF 214169ING <br />4 Pajvav <br />DESCRIBE WOAK <br />51� <br />VALUATION OF WORK <br />6h 9':3d Q <br />NOTICEType <br />of <br />Const. <br />Occupancy <br />Group <br />Use <br />Zone <br />THE PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION <br />AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION <br />OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT <br />Size of <br />Bldg. <br />(Total) Sq. Ft. <br />No. of <br />Stories <br />Fire Sprinklers <br />Required O Yes t2 No <br />OFF STREET PARKING SPACES <br />ANYTIME AFTER WORK IS COMMENCED. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />No. of <br />Dwelling Units <br />Gww.d Uncovwed <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK <br />WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE <br />GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />Legal <br />Description <br />TRACT BLOCK <br />LOT NO. <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW <br />REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION <br />Special Approvals <br />Required Received <br />Not Required <br />ZONING <br />FLOOD PLAIN <br />SIGNATURE OF CONTRACTOR OR A ORIZED AGENT (D_A/T9`) <br />WETLAND <br />r%C <br />DRAINAGE REPORT <br />SIGNA U OF #WNA (IF OWNER BUILDO) (DATE) <br />OTHER (Specify) <br />IMPORTANT TO APPLICANT - PLEASE READ <br />EASEMENTS U Yes O No (9 yes. pfwid. copy of secmn map) <br />SPECIAL CONDITIONS <br />SEPARATE PERMITS REQUIRED FOR: <br />PLUMBING # <br />HEATING, VENTILATING <br />OR AIR CONDITIONING # <br />APPLICATION ACCEPTED BY <br />Lo --4 A� <br />PUNS CHECKED BY <br />APPROVED FOR ISSUANCE BY <br />ELECTRICAL # <br />BLACKTOPPING # <br />CONTRACTORS LICENSE N <br />SEWER # & WATER # <br />THIS IS AN APPLICATION ONLY <br />THE PERMIT WILL BE ISSUED AFTER <br />STATE J NOTREOUIRED J YES .I PENDING <br />PERMIT FEE $ <br />PLAN CHECK FEE <br />SURCHARGE <br />REVIEWAL OF THE APPLICATION. <br />SWM CHARGE -- <br />LICENSE CHECK $ <br />TOTAL FEE $ <br />RECEIPT N <br />a Sa3 <br />