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N2 0355
4 1.) PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELECX PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /1 3 &t PLAN NO.
OWNER ite.e., 4.0
DESIGNER
USE /NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR az7.,LCil2! /v-0,744.4.-- Electric Serv. New X Change Temp Type y /G7 Volts 3/41 Amps /PO
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation 0 0 0 0 Permit Fee Paid S CL 0 Park Dedication
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ISSUED BY 1■66/ Date 7/6' Final /O.P. 7" fir
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER DATE
ADDRESS TELEPHONE