HomeMy WebLinkAboutDOC-1999-Permit Application - h .
SITE ADDRESS: �y ! �3 f ASSESSOR NO.:370 P OOLo-DbO -p cc>O
LOT:P� BLOCK: DIV: ADDITION:
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Name: Name: Name:
Mailing Address: Mailing Address: Mailing Address:
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City: State: ZID: C State: Zip City: State: Zip
Phone No.: Phone No.: Phone No.:
Contractor License:
Contact Person: Phone No.:
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OCCUI'AMI`>U-
(Check One)
Single Family: Multi-Family: Apartment Condominium: Senior Housing:
Retail: Office: Restaurant: Manufacturing: Storage: Bank:
Assembly: Accessory: Automotive Repair: Other(Specify):
DESCRIBE OF WORK: t � f `i- .Qef,o yc'A/y n c�rv41zt.��t
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.Street Setback ,... .... .. •. 'ft.`...................... 2nd Floor:..^.......................... sf., Circle Y or^ ;:::.:.....::::.x.x;:..>..<::...:..:.:,..x:..:.::x.:x,..:... .. :.x... .. ..x,..
1st Side Setback: ft. 3rd Floor: Sf,
2nd Side Setback: ft. Basement: sf. Shoreline(Wetlands Y N
Rear Setback: ft. Ore. Group: Water on/Adj. to Property Y N
Use Zone: Carport Area: sf. Soils Report Y N
Type of Construction: Garage Area: sf. Sensitive Area Y N
Lot Area: sf. No. of Stories: Latecomers Agreement Y N
No. of Dwellings: Building Height: Fire Hydrant(250 FT) Y N
Lot Coverage: Deck Area: Sf. Variance Y N
1st Floor: Sf. Covenant Y N
Project Valuation(Labor and Material Cost)11 7 Sb,�
THIS APPLICATION IS RECEIVED BY THE BUILDING OFFICIAL UNDER THE PROVISIONS OF THE UNIFORM BUILDING CODE, AND SHALL EXPIRE
BY LIMITATION AND BECOME NULL AND VOID IF PERMIT IS NOT OBTAINED WITHIN 180 DAYS OF THIS APPLICATION. BY AFFIXING MY
SIGNATURE I HEREBY CERTIFY THAT I AM THE LEGAL OWNER OF THE PROPERTY FOR WHICH THIS APPLICATION IS ISSUED OR AN
AUTHORIZED AGENT OF THE OWNER ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT,INCLUDING CALLS FOR INSPECTIONS.
SIGNATURE: DATE:
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SITEADDRESS: �r1�-025f�9 ASSESSOR'SNO .: 1fit$-W6-004/?!
LOT: BLOCK: ADDITION:
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Name: r,�,ie���.s /Aif K;116 4 ��irril� Namer %
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Mailing Address: '�/�- /<� ��. Mailing Address.
City:�i ; /,,,L State: Zip: 9 F 7 1 J City: S'w„ y State: l,�kip: 0 1
PhoneNo.: < ?�d/5 -�R3 PhoneNo.:
Contractors License No.:6,01
01
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NO: Tempe of Fixture NO: Type of Equipment
yWater Closet 1.5 OFF Air Cond. Unit HP
`3 Bathtub Refrigeration Unit HP
Shower 2.5 GPM Boiler BTU/HP
Dishwasher 2.5 GPM -el Forced Air System BTU
wl Lavatory 2.5 GPM Floor Furnace
e/ Kitchen Sink 2.5 GPM Wall Heater
7 Clothes Washer 1/ Clothes Dryer
Urinal 1.0 GPM Ventilation Fan
Drinking Fountain Range Hood
Floor Sink or Drain Air Handling Unit CFM
Cf
Slov Sink Pre-Manf. Stove or Fireplace
Water Piping Gas Fireplace
Hose Bibs 5✓ Gas Water Heater
Back Flow Prevention Device Gas Piping
Other(Describe) Other(Describe)
GAS: ELEC: OTHER:
THIS APPLICATION IS RECEIVED BY THE BUILDING DEPARTMENT UNDER THE PROVISIONS OF THE UNIFORM PLUMBING AND MECHANICAL
CODES AND SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID IF PERMIT IS NOT OBTAINED WITHIN 180 DAYS OF THIS
APPLICATION. BY AFFUUNG MY SIGNATURE I HEREBY CERTIFY THAT I AM THE LEGAL OWNER OF THE PROPERTY FOR WHICH THIS
APPLICATION IS ISSUED OR AN AUTHORIZED AGENT OF THE OWNER. ALL PROVISIONS OF LAWS AND ORDINANCE GOVERNING THIS TYPE OF
WORK WILL BE COMPLETED WITH,WHETHER SPECIFIED HEREIN OR NOT,INCLUDING CALLS FOR INSPECTION.
SIGNATURE: DATE: