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N°_ 45338
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC..IKPLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS gl 14-3Ke 'e (a a y PLAN NO.
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OWNER O r r Y
DESIGNER dd
USE/NATURE OF WORK P I(J' (0''e_ tak P- K/I
45 no e /tcf• a^ aX C 604 ,led
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 6 Pt s e r
Electric Serv. New Change Temp Type ,r� Volts Amps
Fixtures Switches 2 Receptacles `Y 6' Circuits 3
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: Valuatio 41 erm Paid :ahb01 k Dedic
ISSUED BY 1PA .A r i Date 4 e FA al/O.P.
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In the performance of this work I agree to rform all work pursuant to rules governing the described construction.
NAT f g_^ ?s
SIGNATURE G U
AGENT /OWNER DATE
ADDRESS 2?( Ct ikaet -Ce -ice c ti .2_ rmI
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