HomeMy WebLinkAboutAPP-1992-Dentist Office - COMMERCIAL DATE (
SITE ADDRESS
NAME(OR NAME OF BUSINESS) NAME: NAME:
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MAILING ADDR SS: A I AD// 'S: M LI ADDR SS:
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CITY: CITY: CITY:
STAZIP: \\AZIP: STATE: ZIP:
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TELEPHONE NUMB R: TELEPHONE NUMBER: TELEPHONE NUMBER:
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PROJECT COORDINATOR: TELEPHONE NUMBER: S ATE&'CITY NS O.
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LEGAL DESCRIPTION OF PROPERTY AND ASSESSOR'S NUMBER
LOT (a 3 () BLOCK y OF I 1W() IVI mA ) �To
IA.
ASSESSOR'S NUMBER
DESCRIBE WORK �L'S^�
OCCUPANCY USE
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• PLEASE SPECIFY
GENERAL INFORMATION
STREET SETBACK SIDE YARD SETBACK REAR YARD SETB Ki USE ZONE
OCCUPA C GROUP CONS RUC ION TYPE LO T AR A VACANT SITE
2 5 ��W YES NO
DWELLING UNITS SIZ OF BLDG. SQ.F . NO. S ORI S O.O BEDROO
DECK SQ.FT. FIR T FL. SQ.F SECOND FL. SQ.FT. THIRD FL. SQ.FT.
BAS MEN SQ.F C POW SQ.F GARAGE SQ.F PLANS CH CKED BY
ANY WATER ON OR ADJACENT TO PROPERTY
- •
RECEIVED
LATECOMERS AGREEMENT YES NO �
FIRE HYDRANT WITHIN 250 FEET YES❑ NO
PROJECT VALUATION: 7rJ� I=1�L4fHfG� ZfJ°O v) IWIS(ii = 2 (� ly �j DU
"m%Bu1LD%BUILD.PMa / OVER
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PLUMBING MECHANICAL
CONTRACTOR: CONTRACTOR:
PHONE: PHONE:
rNO. TYPE OF FIXTURE OR ITEM NO. TYPE OF EQUIPMENT
WATER t!EUSE I AIR CONEY. UNIT
BATHTUB REFRIGERATION UNITP
LAVATORY BOILER HP
SHOW R FORCED AIR SYSTEM B /KW
INK FLOORFURNACE
DISHWASHER WALL HEATER
LAUNDRY SINK
CLOTHES WASHER CLOTHES DR R
WATER HEATER VENTILATION FAN
URINAL RANG HOOD
DRINKING FOUNTAIN AIR HANDLING UNIT CFM
FLOOR SINK OR DRAIN PRE^ AN .STOVE OR IREPLAC
SLOP SINK 0 GAS PIPING
WATER PIPING
NOTICE
THIS PERMIT IS ISSUED BY THE BUILDING OFFICIAL AND,UNDER THE PROVISIONS OF THE UNIFORM BUILDING CODE,
SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID IF THE BUILDING OR WORK AUTHORIZED BY SUCH PERMIT
IS NOT COMMENCED WITHIN 180 DAYS FROM THE DATE OF PERMIT ISSUANCE,OR IF THE BUILDING OR WORK AUTHOR-
IZED BY SUCH PERMIT IS SUSPENDED OR ABANDONED AT ANY TIME AFTER THE WORK IS COMMENCED FOR A PERIOD
OF 180 DAYS..
BY AFFIXING MY SIGNATURE,I HEREBY CERTIFY THAT i AM THE OWNER OF THE PROPERTY FOR WHICH THIS PERMIT IS
ISSUED OR AM AN AUTHORIZED REPRESENTATIVE OF THE OWNER.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER
SPECIFIED HEREIN OR NOT,INCLUDING ROUTINE CALLS FOR INSPECTIONS.
SIGNATURE OF OWNER OR AUTHORIZED AGENT DATE
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