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PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG X ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS TOO (L'' /i c-h t°SYr!^ AP' e- PLAN NO.
OWNER I 4 Ce "29 /t/
DESIGNER
USE /NATURE OF WORK o/ P/Z /`S 2 4
BUILDING CONTRACTOR
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR 7 4: s /A- 4 1 -1 1 G.-
Heat A/C Vent Fuel /System CO A' Heat Loss
ss TU'S /AI /`i 4 6/e
ELECTRIC CONTRACTOR
Electric Serv. New Change Temp Type Volts Amps
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- CAlI2 Permit Fee Paid 7.- ci 1--*". Park Dedication
ISSUED BY Date "AMi
Final /O.P. Pi 93
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER
,c� n DATE C
ADDRESS vO -furl /4,4 (�JL eo)I/ ,93/--/99 7
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