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Z!2.-fH ylllflLL S BUILDING PERMIT APPLICATION CENTRAL PER~ITTING OFFICES: .............. ................ .......................................... ~~~~~::~ ~~:~ :~i~j JU~~;~llU~L ':::::::: :::: ::::::::::: :::::. :NO::;O!!:UNrrSi::.~~~~___ .;;;:; .............................. :f~. R~S,W!0~:. .~~>:':.. ~~W :::::::,,: ..;;;: .;;; .. ..... ................. .................... .......... ............................................................ ....... ............. . . ..... .... J~F$.; tON$rr~@:1 oHi:::. I::..i:i.::: ~ ~ 1;::' l~.'::v':. YI::: ........... .......... ........... ... . . . . . . . . . . . . . . . . . ............................. ....... ........................... - ~. 1(r:'~-;~'l dO' La K e s lHIS APPLICAlION MUSl BE TYPED OR PRINTED IN INK -------------------------------------------------------------------------------------------------.----------------------- G I ~~~~:~~A ~~~~; ==~q=~!~==Z~~f~===~~1!;!=~~?t[:.Ei=!}1Y-~~~~~ V~ ~IO~:..~~~ ~l.~=&l~====_______ '"" PARCEL IDII: S T R SUB BU, LOT PROJECT II:"":::':"::: TAZ ~:::~~", LOT SIZE X OWNER'S PRESEN1-ADDRESS; f:-=~=~~===~~~___========____ CiTY-~~~~t~~~jj~:::::-- STATE~~~~_(_ ZIP _~~~~:r 0::: L:.:: Z ~ I FEE SIMPLE TITLEHOLDER'S NAME (if other than owner): __________________________________________.________________ ADDRESS (if applIcable): ___________________________________ CITY _______________________ STATE: ____ ZIP __________ ------------------------------------------------------------------------------------------------_.~---------------------- t3 I DlSCRI PT I ON OF- WORK: _:2:<;..":::::.:.'!::.f..__~e.~~_s..______.::.~'!_~;?_____________________________._______________________ ~ LI V 1 NG AREA: __________ PA TI 0: GARAGE: EN TR Y : TO r AL UNDER ROOF: __.LfJ:_ II BEDROOMS: .. BATHROOMS: . TYPE CDrSTRUCTION: 0 BLOCI~ 0 FRAME 0 OTHER: z '-" ~ I IF ~OBILE HOME OR RV: MAKE c... YEAR SIZE ----------------------- .... ....................................................... ....................................................... ...................................................... ....................................................... ...................................................... --------- ::!::j::j::: ~~~~:i~!L::::ii: ::::: :::i: :::' ..... E3 I WORK CODE: JJJjj::. PLANS ON FILE?: 0 NO U) VA~UATION: s__~_~_~_~_____ ....................................................................... o YES :::mt+PA~D.::F.~$::f~~HF:UJ>;"LU1:: :: ~~ R ~:!~ 1::!: ~:::::: U:!: U:!! UUUUJJ:: ~:! dUD.:. c: ~ u . BONDING COMPANY: ADDRESS: i)AJ/t- ----------------------------------------------------------------- CITY STATE ZIP ~ '-" ;; . ARCHITECl/ENGINEER: _~~~_~_____________________________________________________ ADDRESS: CiTV STATE ZIP c:: ~ = b . MORTGAGE LENDER: ADDRESS: '"j)-JA- ----------------------------------------------------------------- CITV STATE c:: C E-< v < 0::: Z o u JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT" TOTAL PERMITTING FEES: t * t * NOTICE * * * * BOTH THE OWNER AND CONTRACTOR OF RECORD (License Holder) MUST READ AND SIGN THE REVERSE SIDE OF THIS APPLICATION ------------------------------------------------------------------------------------------------------------------------- A~L PREVIOUS EDITIONS OF THIS FORM ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF