18-007 AKA 18AB-007 (6) quitioti
7/1-# «� _ �, BU {LDING o°
04,1 ' ,, 0/0 PERMIT
f VALIDATION
11
DA .E ....... 1 �, ERMIT,JiIO. • a 0
APPLICANT r 1 , . It* ..r . .�.,., ` � .ai - ADDRESS J _ .... � • + IO
(NO.) (STREET)
(CONTR.'S LICENSE)
INS
OF
'°• ., PERMIT TO .+a/* (_) -TORY DWE UNITS
(TYPE OF IMPROVEMENT) N0. (PROPOSED USE)
' AT (LOCATION) • • ZONING
DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION I LOT BLOCK SIZE e ,
0
BUILDING IS TO BE FT. WIDE BY . FT. LONG BY l IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP t BASEMENT WALLS OR FUNDATION
(TYPE)
REMARKS: , / or / jj " ' w m 1 •
VOLUME { ESTIMATED COST .$ 'jI o o PERT Mt `•�{
(CUBIC /SQUAR FEET 8
OWNS • BUILD 404,0 ,
A...ES 771,1 �. a "..w. K :.,,. s.. fir a. . BY "
WHITE - FILE COPY • GREEN - FIELD /COPY • CANARY, ^ APPLICANT COPY • PINK - ASS ORS COPY
y
.4 ' ` - BUILDING V htZ
49443 It PERMIT /..) c,
VALIDATION
/ ^y DATE `o 19 d PERMIT O. �e ?2,
APPLICANT jLLL aro "Q' y. ADDRESS C t l
(NO.) (STREET) T (CONTR'S LICENSE)
NUMBER OF
- PERMIT TO ( 1 STORY DWELLING UNITS _
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) • / ' ° DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
/��\\ (TYPE)
REMARKS: .a� oI ` J i4t44
AREA OR VOLUME ESTIMATED COST $ - 1 �-'0a 0 0 FEE MIT /A a
�1 (CUBIC /SQUARE FEET)
/ +
OWNER `Y PO _ - 1,ga- 7y� /�� BUILDI ' y� ( / ^ J / .iiii. J....
ADORESSN bKS' TC Q+i V F �+r f / r�. BY � � ^' L.7�
WHITE - FILE COPY . GREEN - HELD COPY • CANARY - APPLICANT COPY • PINK - ASS ORS COPY
k
1
v —.
/6) ,r 6 , 7 APPLICATION FOR
I PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
I AT (LOCATION) ZI !! l �/to
• f`I AK DISTRICT 1Ls[L
LOCATION (N0.) (STREET) r�
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
en
1I. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
xi
A. TYPE OF IMPROVEMENT D. PROPOSED USE – For "Wrecking" most recent use m
M
1 1 I New building Residential Nonresidential
2 1 Addition (If residential, enter number 12 1 One family 188 Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 I Two or more family – Enter 19 Church, other religious
number of units– – – – -÷ 20 Industrial
3 X Alteration (See 2 above) 14 I Transient hotel, motel,
21 Parking garage
4 I Repair, replacement or dormitory – Enter number
5 I I Wrecking (If multifamily residential, of units – --3.- 22 Service station, repair garage
enter number of units in building in 15 I Garage 23 Hospital, institutional
Part D, 13)
16 I 1 Carport 24 Office, bank, professional
6I 1 Moving (relocation)
17 I 1 Other – Specify 25 Public utility
7 1 Foundation only 26 School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 y Private (individual, corporation,
28 Tanks, towers
nonprofit institution, etc.) 29 Other – Specify
9 I 1 Public (Federal, State, or
local government)
C. COST (Omit cen, Nonresidential – Describe in detail proposed use of buildings, e.g., food
' processing plant, machine shop, laundry building at hospital, elementary -.1
10. Cost of improvement $C /.0i r� school, secondary school, college, parochial school, parking garage for
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost £ at a. Electrical ilAb7,tL' L ,/r 64 f ter Ai
b. Plumbing r
c. Heating, air conditioning
�1 r /! ' 4
d. Other (elevator, etc.)
--" jleCll
11. TOTAL COST OF IMPROVEMENT $ 1 /1200
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. T PE OF SEWAGE DISPOSAL J. DIMENSIONS J
30 Ti Masonry (wall bearing) 40 ublic or private company 48. Number of stories /
31 I Wood frame 41 i Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior jj/
32 Structural steel ` dimensions 2 01 40.1'7
33 Reinforced concrete H. TYPE OF WATER SUPPLY
34 1 1 Other – Specify 4 Public or private company
50. Total land area, sq. ft.
43 � Private (well, cistern) K. NUMBER OF OFF STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed
3.
Gas Will there be central air 52. Outdoors 5D —1 "
36 Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 1 1 Electricity 44 Yes 45 1 1 No 53. Number of bedrooms
38 I I Coal
39 1 Other – Specify Will there be an elevator? 1 Full
54. Number of '
46 Yes 47 1 1 No bathrooms % Y
Partial
NOTES and Data — (For department use)
l (:)".42■41■7 1
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing addre — Number, street, city, and State ZIP code Tel. No.
}
a or F 4 ✓ L yam, 31 H ' I ' V 44-1 'I . Adw»E!tr,,o0 2 351-6.075
essee ehrelr J 5GL 6 .
2. �� _ MA, 33 g T F 6 Builder's AVE-La
W License No
Contractor
7\er4 a I,) lb s a,lz , A1 oi09t, .54 - s$44L.
3.
E
Architect or (\t/ik
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to
make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdi
re of applicant Address Application date
• t4e.,trNo‘A......■■•• Amn&e47 a , leperen, 11.4 if 41.,-
- S . OWES /heg D O NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number By Permit or Approval Check Date
pp Obtained umer Obtained
Number By
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building � � FOR DEPARTMENT USE ONLY
Permit number (gA
Building Use Group
Permit issued cad 19 RL
Fire Grading
Bui [ding
Permit Fee $ Live Loading
Occupancy Load
Certificate of Occupancy $
Approved by:
Drain Tile $ ` t I.
Plan Review Fee $ 44�
_ ��
' 111111111r TI LE