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NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name / Mailing address — %'rnnbcr, sIrc (, cit%,-aml ZIP code Tel. No.
Owner or J � w '� i i� � / �L'
Lessee �7 d Y j'3
Builder's
[, 119 License No.
Contractor
3.
Architect or
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 jurisdiction.
Signature of applicant Address Application date
L D0 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 Is
OTHER Is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Permit or Approval Check Obtained Number By Permit or Approval Check Obttaineed 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
Permit number 191
Building
Permit issued June 1, 197
Building f f
Permit Fee $ '
Certificate of Occupancy S
Approved/,by: ,
Drain Tile
Plan Review Fee S-
BUILDINGINSPECTCIR
TITLE
o� ro
�IIFISScTCIjiTSCtfS
UT (Office of the 31noptrter of Auilbfivs
APPLICATION FOR
ZONING PERMIT AND
Page- Plot 5 BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. p
I• AT (LOCATION) ' l / ,�it /LG/ DISTRICT
j r
DISTRICT
LOCATION NO.) (STREET) t,
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D m
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
1 ❑ New building Residential Nonresidential
2 (
Addition(If residential, enter number 12❑ One family 18 ❑ Amusement, recreational
J� of new housing units added, if any,
in Part D, 13) 13 ❑ Two or more family — Enter 19 ❑ Church, other religious
number of units— — — — —> 20❑ Industrial
3 ❑ Alteration (See 2 above)
14❑ Transient hotel, motel, 21 ❑ parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (If multifamily residential, of units ——————— — -� 22 Service station, repair garage
enter number of units in building in I5NGarage 23 ❑ Hospital, institutional
Part D, 13) `` 24❑ Office, bank, professional
6 Moving (relocation) 16 ❑ Carport
❑ 17❑ Other — Specify 25 ❑ Public utility ^
7 ❑ Foundation only fl!L 26 ❑ School, library, other educational }
B. OWNERSHIP z 27 ❑ Stores, mercantile
8 ❑ Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 29 ❑ Other — Specify
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,•••••••...
school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be insealled but not included If use of existing building is being changed, enter proposed use.
in the above cost �>
a. Electrical.....................
b. Plumbing .....................
c. Heating, air conditioning..........
d. Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT 1$
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, y
0
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS Rl
48. Number of stories...............
30❑Masonry (wall bearing) 40 ❑ Public or private company
❑ c tank, etc.) 49. Total square feet floor ores,
41 Private se ti "
31 Wood frame (septic all floors, based on exterior
32 Structural steel dimensions .....................
33 Reinforced concrete H. TYPE OF WATER SUPPLY
42 Public or private company 50. Total land area, sq. ft. ...........
34❑ Other — Specify ❑ p p y
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ....................... r
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL O
35 Gas Will there be central air 52. Outdoors........................
36 ❑ Oil ` s conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other — .Specify Will there be an elevator? 54. Number of Full..........
bathrooms
46 ❑ Yes 47 No Partial........
1 hereby certify that the proposed work is authorized by the owner of record
and 1 have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OF' AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
CITY olP NORTHMM BUILDING 7 I
PERMIT
VA LlDATION
DATE juna 11~ 19 27 PERMIT NO. 191
APPLICANT_yStaphen HAAS ADDRESS .�6 X&=ItT �*
(NO STREET (CONTR'S LICENSE)
PERMIT TO Add 11B �e (_) STORY ' ao, abed NUMBER OF
DWELLING UNITS
(TYPE O IMPR EMENT) NO, (PROPOSED USE)
ZONING
AT (LOCATION)
16 Marahall Street DISTRICT UHB
(N0.) (STREET)
rn BETWEEN AND
a
(CROSS STREET) (CROSS STREET) .
LOT
a SUBDIVISION LOT BLOCK SIZE
m
4
O
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
0:
o REMARKS: Add an to garage for tool ahgd
AREA OR P
VOLUME ESTIMATED COST $ 200-00 FEEMIT a-0- 1
(CUBIC/SQUARE FEET)
OWNER -gteyi1_heAn�L_P 1�1E�l� do$
ADDRESS 1.6 Harshei, Street,-X"th&Ap-tm
(Affidavit on reverse side of application to be completed by authorized agent of owner)