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<br />- <br /> <br />APPLICATIOIN1 FOR PR1UIIT <br />CITY OF ZE.'PIIYRIULI.s <br />BUILDIIN1G DEPAR'IHE',I/IT <br /> <br />Ok"NER 'S NAME <br /> <br />'~ol/ <br /> <br />)Pr-20 9 <; <br />j"Js-y- 0 <br /> <br />.Y:-c.. 1" 3 15-' 0 <br />, <br /> <br />2~~y A-eY'{~5 <br /> <br />R: <br /> <br />--#7i'(j"Lt"'e~ ,.;.. <br />OWNER'S ADDRF..SS 79/110 6!t,. Ave 2~1t'". ~/;; <br />31 ( 60 6' f-l... 4v--c 2 ~,?A't1'/,4/ 16 <br />LEGAL DF..sCRIPTION: LDT(S) 29 RL.OC.K I SOODH"ISION' <br />t~'r ..,PARCEL LD.I 12-2'-],/- 0036-00/00 - c) 290 <br /> <br />(lV <br /> <br />PlIONE <br /> <br />JOB ADDRF..SS <br /> <br />"'URK PROPOSED:_!!i!eW' Construction --t..L,Addition _Alteration _Repair -----=:Install <br /> <br />_Sign <br /> <br />_Hove <br /> <br />_Demolish <br /> <br />PROPOSED USE: <br /> <br />~gle Fanily <br /> <br />_H/F <br /> <br />_, of Units <br /> <br />_MIll <br /> <br />_Coaaercial <br /> <br />_Indust. <br /> <br />_Swim. .Pool <br /> <br />Other <br /> <br />_Restaurant & Health Departllllen.t Approval <br /> <br />BUILDING SIZE: <br /> <br />/J x4. <br /> <br />~ <br /> <br />Square Feet, g 1/ <br /> <br />Height <br /> <br />RESIDENTIAL: <br />COHHERCIAL : <br /> <br />ATTACH (2) PLOT PI..ANs & (2) SETS OF nu;u.nING PI,ALli1S Ii: 0) SET ENERGY FORMS. ** <br />ATTACII (3) SI!.TS OF BUll.D~G PLANS & (1) SET ENERGY POR~IS.~~ <br />~~COPY OF COllITRACT REQrnmED. <br /> <br />PERMITS REQUP.STED <br /> <br />V-;;~LDING <br />_\....m.ECTRICAL <br /> <br />s <br /> <br />..-., )... ...... - <br />r:./ c.. 1;. }.) <br /> <br />Valuation of-Total Constnlction <br /> <br />/o,J <br /> <br />MfP Service <br /> <br />~ida PO\<'er COrp. <br /> <br />W.R.E.C. <br /> <br />_MECHANICAL <br /> <br />$ <br /> <br />Valuation of Mechanical Installation <br /> <br />_PLlJMBIHG <br /> <br />GAS <br />LBloCk <br /> <br />ROOFING <br /> <br />SPECL\LTY <br /> <br />TYPE OF CONSTRUCTION: <br /> <br />_FraJlle _Steel <br /> <br />Other <br /> <br />FINISHED FLOOR EI.EVATIm~S: <br /> <br />IT . <br /> <br />IS PROJECT IN FInOD ZONE ARR~? <br /> <br />YES NO <br /> <br />~~~~~~*~~~~~*~~*~~~~*~*~*~~~~~***~*~~*~*** <br /> <br />Run.DY.R <br /> <br />CONTRACTOR SRCT'ION <br /> <br />'. cnHPAtJY 0{LryJ7~ <br />f'~' / If 'St:ate Cert. or Rcgist. #! <br />cJtl ~ Cit:y License Registxation ;I: <br />~****~*~******~**~****~**********~******** <br /> <br />Signature i/ <br /> <br />Si <br /> <br />F.T.F.CTRICTAN <br />a tllre ~ <br /> <br /> <br />aMfPANY (!) I.rryUA_) <br />Stat:.e Cert. or Rcgist. if <br />Cit:}~ :.icense Registration iJ <br />********************~~~*~~~*************** <br /> <br />PT.UKRER <br /> <br />Signature <br /> <br />CO'MPAJIlY <br />State Cert. or Regist:. ~ <br />City License Registration g <br />~~**~****~**~~********~*****~************* <br /> <br />HF..ClT.MqCAL <br /> <br />Signature <br /> <br />COHPAJIlY <br />State Cert. or RcgisL 'If <br />City License Registration ~ <br />**********~******~~***************~*~***** <br /> <br />Signature <br /> <br /> <br />COHPA~~Y 'G.-~~ otS(l,.J ~ C(JI\ST ~ rY) ( , <br />State Cert. 0 Reg st.. i# CRe '-f~ll '-- <br />City License Registration !If ~ ~ <br />******~************************.****~***~* .. <br /> <br />APPLICATION APPRO\TD BY <br /> <br />PERmT OFFICER.- <br />