HomeMy WebLinkAbout0000011-Building (Raze house 1986)
~ PERMIT - c;.~~L~6A~~~:~~~ RECORD N~
r /;J,e.~J:;..1 IX- 1/ y
~~~P_E~ _ _ ~L~~ f1- ~T~. ~ _ ~~E? _ ~ _ ~~B~ _ ~ _ ~I~~ _~ _ ~O_N~N~ _ ~~~ _F~~~D_ ~~I~ ~~~~I~~T~
ADDRESS 11 J 0 t1v 6 6ARfJ
OWNER fJEf-J tJ IS. l)(E"e.J+{
00011
~
23~"-&S:-7~
DESIGNER
USE/NATURE OF WORK ~3pr ~~ Nz::;uSc=-
BUILDING CONTRACTOR CJ(.A-.:>)--J6/i-.
Size Sq. Ft. r . g ~ ~# Rooms
Foundation
# Stories
Height
Occupancy Permit
Class of Const.
HEATING CONTRACTOR
Heat D NC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New D Change D Temp D
Type _ Volts ----'- Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR [JAu"'E_ F/l..4-t.-J I=-..
_BT _WH _Disp
_Lav _Sh _DW
_WC _FDr _SP
_Sink _ L Tub _ Eject
Other
_ WSoft
_DF
_ CBasin
_ San. Sewer
_Ur
_ Storm Sewer
_SS
_ Water
Permit Fee Paid $
/
s:~. V'
C:;-4~-g~
Park Dedication $ ~.-6'--
Final/O.P. l' - q - i{tp
-~
Date
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ~dJ~ ,$ ~ h- 91-J'/;
./ AGENT/OWNER DATE
ADDRESS
TELEPHONE #
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RECORD OF SEWER AND WATER DISCONNECTIONS
~
Jt~C
~
.
Date
Address of Building ~!(O 1:17:/
Name of Owner ;JeA 1,.1 <.. - -<:.- -
Address of Owner' i ;o~ I~ lie. !lA/(
6/C(~
u:
19_by
19_by
Sewer Sealed at Property Line
Water Disconnected at Property Line
No sewer and water services to premises.
o
I, the undersi.gned, owner or agent of the above de scribed property,
agree that all sewer and water services will be disconnected and
. sealed by a master plumber on or bef~e
$ef/Jer-a/IA-/ U/a<~ &</;/! h~ re-{/--5<::~ ~.P.~ ~
(J"- eN-- be-k.;-<- ?/,?!t Cl9~e:J. (Agent)
Approved for issuance
6'/'7/&
Date
of wrecking or ~~~~
pru ing Inspector