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PERMIT — APPLICATION AND RECORD
81
35429
TYPE: BLDG HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING - - FLOOD PLAIN- - - HEIGHT
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ADDRESS 1 k y A,,Al PLAN NO.
OWNER
DESIGNER
BUILDING CONTRACTOR
Size / 2- �Zy® Sq. Ft. # l400ms I # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR `/
Heat ❑ A/C ❑ Vent ❑ Fuel /System
Heat Loss
ELECTRIC CONTRACTOR 45&
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
BTU'S
PLUMBING C'ONTRAC'TOR
BT
WH
Disp
WSoft
CBasin
Lav —
Sh
DW
DF
San. Sewer
_WC —
FDr
SP
Ur
Storm Sewer
Sink
LTub
Eject
SS
Water
Other
FEES: Valuation $ lS� G O ® , % Permit Fee Paid $ 67 Park Dedication $
ISSUED B Date l Final /O.P.
In the performance of this work agree to perform all work
SIGNATURE
ADDRESS
to rules governing the described construction.
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DATE
TELEPHONE #
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OWNER_ J
DATE ' PERMIT #
GENERAL CONTRACTOR
MASON CONTRACTOR
Width of lot
ZONE
Front of lot
DATE
ADDRESS
USE
Work consists of
INSPECTIONS
REMARKS
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