|
813-7eo-oozo City of Zephyrhips Permit Application Fax-818-780-Op21
<br /> ' ' Buiiding Department _
<br /> Date Ftecelved . : p}���g��anfact�for:Fertntttin 1 _ �
<br /> ' i
<br /> Owner's Name �t,1 G 41 ' (,3 t" v i Ge S Owner Phone Number
<br /> -� -
<br /> Owner's Address I"C� �U ��'7 l C;w� 0 �cc�+t� Ixl, 3,,`��wner Phone Numlaer �
<br /> � �
<br /> Fee Simple Tltlefiolder Nama ' Owner Phane Number
<br /> Fee Simple Tltleholder Addresa - -
<br /> JOB ADDRESS � c�',� c� � (' � 1� �`� LOT# �__�
<br /> SUBDIViS10N �� � , PARCELJD# . . '
<br /> , ,- (OBTAINED FROM.PROPERTYTAX NOTICE)
<br /> WORK PR4POSED � NEw'CONSTR ADQtAt.T � SIGN" � Q DEMOLtSH
<br /> _e INS7'Al:l. 8 ` REPAIR
<br /> RROPQSEDztJSE � • Q $FR Q GQMNI .. � -QTHEF2 .
<br /> TYPE OF CONSTRUGTION - Q `� BLOCK " [� FRAME � C] STEEG 'Q
<br /> DESCRIPTION OF WORK` „ " � rrLc..�'P `t,r1, ' t,•��2�t�, . IC- S 6�z`"� .`-�-- ��S .
<br /> BtlILD1NG SlZE � :34�F00?AGE��; .� HEIGF#t [�� , �.,s 5
<br /> QBUl1.DING ' � � VALUATi�N:CSF�TOTAL CONS'i`F2t1C1'ION , _,
<br /> QELECTRICAL ` �y� AMF SEI2VIGE Q PRt}GRESS Eh1ERGY ` Q W.R.E.C. ,
<br /> OPLUMBlNG . =�� '
<br /> [~�ECHANICAL � ��� VALUATI4N QF,MECHANICAt.INSTALLATIt?N ,
<br /> ,�7�5,
<br /> QGAS [� ROQFlNG Q SPEC1Rt.TY �� OTHER l�t✓
<br /> FINISHED FLOOR ELEVATIONS �� FI.00D ZpiVE AREA QYES NO
<br /> ^Y �
<br /> �V��V�iR LOfl+�l�i� . „ r �
<br /> SIGNATURE REGISTERED Y/ N � �eE cutt►t�n Y/N'-
<br /> Addres$ - ' L''Icense#') " � �
<br /> E�EC'i'RICIAN;, , . � ;COMPIWY . . .
<br /> StGNA7URE � REGISTERED Y/ N FEE CURRE��� �Y/N
<br /> r�
<br /> Addrass - � , ; . . Ltcense#.�. ��
<br /> PI,UMBER '� , � COMpANY �1 ,.. , .
<br /> SIGNA7URE'' ' r'( � � REGiSTERED Y,/�.N�� ,F.EECUFlRE� Y/N.-
<br /> Addre�s License,# r. . -� �,
<br /> MECFfANICAt:' . ;�'y� C , � .,. CONIPAt�tY �3r,���c,�c1 �..(t�' .L�nc.,�-�t�c� ,t�,;c
<br /> fAN
<br /> SiGNATURE " � ` REGISTERED Y./ N � FEE CURRE� Y/-N , �,
<br /> Address:,., /!v -%� i%'"nv��'��ui�.�i`''�r S RGL�� ��ll -�� 3��L�, . ucense#� �1.�`� l..�f�o7c,1�.. � � .
<br /> OTNER . � . " , ''�CDMPANY' -
<br /> SIGNATURE ,"i - -- - � " ` '`REGI$7ERED � Y/ N... � � FEE CURRE� Y/N
<br /> �„t"
<br /> Addre�s . � - ...t�..tfi h,. f : ` ;$ : .. , '�.. . .F; , L`iceii'se# � _ . �a. _�, �F._. •
<br /> . �.,: < ,. .;:;::,:, _ �
<br /> RE3lQENi1At::�,�'; :Attacti`{2)�P:lot;Plans;:,(2)set`s=of{B'u1ldingiPlaiis,{1:).setof:Ertiergy�Forins;:R=Q=W=Rerintt'for,newi�ns#ruc�on�, � . .. ,. . �
<br /> r= Minimum4ten;(:10)'woricing;days.;afEer;submi$aiilate:�;R:equired`onsite;:ConsfiucdonRlans;�Stomiuvate'r'Plans'wl'SiltFencelnstalleil,
<br /> , ,,..,.. ...., . .
<br /> - -- SanitaryFacilftles;&�1;dumpster:$Ite�WorlrPermitforsutidivislons7large:projects-, - � s _, . - '
<br /> � •..- ;- , .. ,
<br /> -.� .,, ,
<br /> � .... . .,. . _ _ ,: <�._ , . __
<br /> COMMERCIAS. Attach{3)�aoii�jslete se#s`of'B'atic}iii�"Rlans plus a Ufe Safetiy Fage;.{1)-set of Enecgy forms.R-Lt W Permtt for nav+i_canstnictton.:��� `�
<br /> Mlnimum ten(10)working days�after submittal date. Fiequtred onsite,ConsUuctlon Plans,Stormwater Plans w/Slit Fence installed,
<br /> Sanitary Facilides&1 dumpster.Site Work Permit for ali new�projects..All commercial requirements.must meet compllance"''�`�"'" ` �' ` "
<br /> �:SIGNP�RMIT AttacFi'(2}.setsaf'EiiglneerediPlans:;.:�:,;->,,': .;. ._ _ . ' � � ' . .. �., .. . .� ,
<br /> •`""PROPERTY SURVEY r ..uired,for_all NEW canstructibn..., - - •� -- - - - " - „
<br /> _. _�i._ __- . . , ,� - , ..
<br /> Dtrectiaris: ...�.,v..;.,.: .; _ _ ;_ . ,,:�,. -
<br /> Filt out applicatlon completely. �
<br /> Owner 8 Conhactor.stgn 4aack of appl[catlon,notarizad
<br /> If ovar�2500,a Not[ce of Catrimencement ts required. {A!C upgrades over ib7S00) , m r ,: . _ _Y
<br /> . ..,. .,
<br /> ; ..._.,: , � _._ � .._ _. _. .
<br /> MY� ��I;,"WYi.�E...t
<br /> . _... .�. _ _.. ... ..__,
<br /> Agent(for the contrao4or)or"Power of Attomey(fraf tFie'owner)wouid be someone with notarized letter from owner authorizing same
<br /> OVER THE COUNTER.PERMIITING-_.._..__.(Ftnnt'af•Appllcatton 0n{ � -,.; . - . " . ' , � ..�.
<br /> Y)" _�'_" .
<br /> Reroo#s If shingles Sewers Service Upgrades A/C Fences(PIaUSurvey/Footage) .
<br /> .._.._ __ ._... _. __,., --. - .. ._ . - . . • � ;,;�y= -- , .
<br /> Ctrlveways-Not aver Counter if an public roadurays:.needs F20W� ' � � ', � �
<br /> _, ' '__'.�f ��
<br />
|