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HomeMy WebLinkAbout122 Jefferson Av -a BUILDING PERMIT APP~LICATIOlV Jurisdiction of CITY OF CAPE CANAVERAL „ ~~S® 105 Polk Avenue n ;v d TELEF'HONE_(305) 783-1391 80.0, , 3 ~7 z ~ o B A D D R E m ss u, 12~ ~O~:Cc..=_~~_o~~~ !-~~roriu__o DATE: Ei-~.-£3~ LOT NO BLK, TRACT ~ ~ l~ LEGAL SEE ATTACHED SHEET) 1 D E SC R. _ ~ t l'~V I:~? I") ~ y jr t >v .5 tiu'' c-3. - 12'+ ilti Owner Mailing Address .-S zip Phone 2 ~ Ccnst~•~a.c°~ion C'.~:~. Oo~ ?'~J, ~.:~~a ~:`~nuv_0=__~.~, F'T:_ 7f~4-~c~l'7 Gen. Contr. Mailing Address Phone License No. `-`t s"1. rt; Elec. Contr. Mailing Address Phone License No. ,-t' (I1 I ~ ~ i Plmb. Contr, Mailing Address - i Phone License Na. c7 5 _ Imo- Mech. Contr. Mailing Address Phone - License No. - O 6 r~ ~ ROOfin COntf. Mailin Address - c~ 9 9 Phone License No. 7 j Specialty Contr. (Other) - Mailing Address T Phone Lireaase~ No. - USE O F B U! L D I N G - 9 ~',=c:ti 1,~02~fr ~.ct x. 10 Class of work: ?NEW ?ADDITiDN ?ALTERA'f10N ?REPAIR ?MOVE ?REMOVE 11 Describe work: .6.- 6.'(,i )~J L~'~~ L. 4 ~x.~E:~ .ki'4'~i LS.i*ii C't ~ I NOTE: RECIUIREI~ INSPECTIONS MUST BE ARRANGE® 12 Valuation of work: ~~SQ , 00 TEL: 783-1391, ALLOW 3 HOURS RESPONSE TIME SPECIAL CONDITIONS: _ Type of occupancy ' Contt. Group Division _.A- _ Size of Bldg. No, of Max. (Total) Sq. Ft. Stories Occ. Load SETBACKS: F R RS LS~~ Fire --i ~ Use Fire Sprinklers - Application Accepted By: Plans Checked By: Approved For 1=nuance By, Zone _ Zone Required []Yes No OFFSTREET PARKING PACES REO.IDIRED ~ . 1~f3x'C~,c~_I4 ~+~~I??E„' ~CTi~~' No. of Dwelling Units _ _ Covered -Uncovered. N O T I C E Special Approvals Required Received Not Required FOUNDATION SURVEY SHALL BE SUBMITTED NO LATER THAPJ FOUR zONING - DAYS AFTER PLACEMENT OF SLAB. HEALTH DEPT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT. AUTHORIZEDISNOTCOMMENCEDWITHIN6MONTHS,ORIFCONSTRUG SOIL REPORT TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 6 - MONTHS. OTI-!ER (Specify) I HEREBYCERTIFYTHATI HAVE READAND EXAMINEDTHISAPPLICATION - AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE PERMITS& FEES CODES COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Building ~ ~ ~ ~t Southern Standard* OF PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR ~N ~ O IONS OF ANY OTHER STATE OR LOCAL LAW REGU- Electric National Electric* ffLAT+I• ION OR THE PERFORMANCE OF CONSTC ON. Plumbing Standard Plumbing* Mechanical Standard Mechanical* igne r Authorized Agent (Date) ~ _ ~ Other CC ~gnature of w Ovyner Builder) (Date) TOTAL ' Y ~ ~ . U ~ *as adopted by ordinance. THIS APPLICATION, Wi-IEN SIGNED, BECOMES A PERMIT TO START WORK: I U I1V ~ F L - CITY OF CAPE CAPJAVERAL BUILDING Pf'RMIT APPLICATION TIiI ~ IS NOT A PI;RMI'1' 'r0 START WORK: I'I' IS AN APPLICATIONI ONLY Aran WILL FiE PROCESSED AS SOON..AS POSSII3LI3. YOf-J WILL 13i~; CALLT~;I7 47III~J I'.(' IS READY. COMPLETE BELOW AI`JD IAI6URE 'rIIA'1' YOU IIAVI3 OC•I f~ :.CLI A. CURREN'T' COPY OF 'TIIE FOLLOWING: (IIOMEOWNER PERMITS ARF' EXEMPT) State License County License and Competency Card Liability ($100,$300,$25 Thousand) anr.1 Workman's Compensation Insurance Surety Bond payable to this City ($].,000) (Only__i_f City__Occupational _ - _ license YE?C~Ulred) _ TYPE OF PERMIT : BLDG . ELEC . _ PLUMij . _ MECII . bT1IER r~, ) PROPERTY OWNER : ~ (~1\)S i ~_'~'1 O(~-- _ L ("J_C,._----I'IiONE-- 7 ~ ADDRES 5 : - STREET ADDRESS OF JOB_5ITE_-_ (Z-Z_ ~J ~_(-=~~2_~-d_t~~s-_- ~ LEGAL DESCRIPTION: LOT~_ L?LOCK` SUBUlV15ION _~Vaht OTHER TYPE OF CONSTRUCTION:~~C:~~~IZE OF BUILDING (TOTAL SQ. FT.) _ __i (¢,Q_-_____ NO. OF STORIES~___ MAX. OCC. LOAD NO. OF DWELLING UNITS USE 7.0NE ~-Z____________________--_.._-.-.-- IVO. OF 1.'ARIC:f.NG SPACES ~r TYPE OF OWNERSHIP (CHECK ONE) DE'rACfiI~D SIPaGLE FAMILY RESIDENCE TOWNHOUSE__ APAKTMEN'I'___-___ COPaDOMIPaIUM_ COMMERCIAL CONTRACTOR ` ~ W ' ~~NS"~'f _ S~rA'rE LIC . 1( A D D R E S 5 ~a ~ 29 ~ ~ P I I O PJ E ~k _ _ ~f- 8 [ ELECTRICAL STATE LIC.I( ADDRESS PIIONE1f PLUMBING `,"PATE LIC . fk ADDRESS PIi0NE1k MECHANICAL STATE LIC. ADDRESS PIIONE~k OTIiER 51'A`I'E LIC . 1~ ADDRESS PHONE)( NATURE OF WORK 'r0 IIE DONE : u ~T_"C~yL~I--- -~--__-C'~~~~__~-_O d~~_-------------------- ~ - VALUATION OF WORK/CONTRACT : J__~_~-- _ - - - _ _ NO_TE_:_ This application is valid f:or. 1-5 wor)c:incx days after which time, unless a permit has been drawn, this form .end aJ_J. attar_hed material will be destroyed. Date: / , Signed ~ ~....-r._ Lir_ertsee,~` ent csf Record or Owner Liv.Area Encl.Area Other Building Permits Chapter 547-A Based on Square Footage Building Permits Chapter 547 Based on Valuation ~ - Building Permits Misc. Based on 547-4 Electrical Permit 547-C.1 Plumbing Permit 547-B.1 rlechanical 547-D Plan Check Fee Total Permit Fee Sewer Impact Fee 537-03 _ Sewer Tap Fee - - - - Total Sewer Fee Fire Impact Fee 537-03 Fire Impact Fee 537-05 Total Fire Impact Fee Radon Trust Fund (FL Statutes) 1 cent per square foot under-roof OFFICE USE ONLY: VERIFICATION: General Contractor Electrica]. Plumbing Mechanical County License Competency Card Insurance Surely Bond, City License ~ - State License Worlt for a lessee, renter, manacTer, agent must have approval of legal owner of record. llomeowners, condomi-mums, townhouses or others*, with an association contra]., architecture and bu:ilclinq r_~.-iteria, must have approval signed by the governing body. * Others is to ]-IIClUde covenants, conditions and restrictions as recorded on deed; however, this office is responsible on]-y far obtaining compliance with the 'Caning Ordinance. w N COt,3 C t~G~"~~. ~ ~-t~ I~ , Tf~.calh! a S~l14 CS'T' F-1 ~'i PJl ~ ~ w~ irk ~ AS2 ~ ~ f~ ~ \f ~ R, Gl._E, ~ tv M^r M P G D o t 1... _ - N e n _ G~1 : ~ ~ sa _ ~ 1~~ ~ w ~ ~ T:. ~ 3; r ,g;~~p ~aY ~.w ,c , r ~ ~ ~ ~ L 1 { < A o ~ l ~ r ~ f: r-- _ E. X t 5 'C i N fs- P ~R. M t S GR.~~..J~C.~ ~.1•?C L©~V(e C . r. r~., . _ . _ A BUILDING PERMIT A,PPLICATIC~fV 0 ~ Jurisdiction of _ ~ CITY OF CAPE CAf`JAVERAL n .d rj9'73 i05 Polk Avenue 2 D TELEPHONE: (305) 783-1301 °D . ~3_- m JOB ADDRESS ~ ci I ~r~~'~~~rsc>xa Avc}nuc:, DATE: ( LOT NO. BLK. TRACT - LEGAL SEE ATTACHED SHEET) 1 DESCR. 7 -~~~Pi__T~C~fllc~s V'.'..i~S ~I _ ~ Owner Mailing Atldress Zip Phone 2 & ~^e iVc=n~i..a.~t~~i-cs~, 7:rir;_ ~'.F~. ~;r.~;~ 2~_~_Ca )E1 ~:una~j~~'~..'L,____~-~~-81'7 c., Gen. Contr. Mailing Address Phone License NO{ C 3 & Ge,' C c~ rg ~ ~ ~`u r~ _ .i c~ r.. r., r:. e3 E? ~ ~ tom. R ? 41 ? 4 x$17 r'__r__ ra Ele orb ~ 16n dress Phone v License filo- - O Cj 4 Hp > rsGr. ~yt c~ ~ " ° ~ r ~C~~F~~S~ ~ ~q_ ~ ~ c~ ~ ~lt~ri t//`i~tF~ Mailing Address /~,/y$/$~ Phone License loo. ~ ~t Mech. Contr. Mailing Address [ 3•~ i~y Phone License No. r' s°~ ~ _ r~ .R. 1 1 G Q 'r) Gt ~ 1=>C-~° ~ ~3.' .t~ , S~° * ry rv~ -~_'3-1_- " ' 1! ~ ~ ~ 6 ~ ~ - ~ • - r AC r~ ~ c ~ E~ ~ ~ .3 - ~ X16 2 ~ ~ ~o `l'6 ~ Roofing Contr. Mailing Address phone License No. O 113 I 7 ~ Specialty Contr. (Other) Mailing Address Phone License Nn. N 8 USE OF BUILDING ~ 9 ~E'.`'=-C(E:'.I•tfi: x-{~1- 10 Class of work: ANEW ?AD®ITION ?ALTERATION ]REPAIR ?MOVE f_7FiEMOt~fE + 11 Describe work: - O Il ~ 7 LP C 'C P. O ~1~ ; i O iLa E~' 1.,i Lt 3_ Ass ET Var'3 ~ Y'fi2 l_ $ ii ~ ~2 ~ J NOTE: REOUIRED INSPECTIt)NS MUST BE ARRANGED 1 2 Valuation of work: ~i ~ r ~ ~ I . ~'t~l 1`EL: 783-1391 ,ALLOW 8 HOURS RESPONSE TIME SPECIAL CONDITIONS: 'Type of occupancy Contt. Group Division _ Size of Bldy. ~ ~ ~ No. of Max. (Total) Sq. Ft. Stories Occ. Load SETBACKS: F R RS LS ~ Fire Use [r-._ ~ Fire Sprinklers Application Accepted By: Plans Checked By: Approved For lssc:r:~nce By: Zone Lone Required Yes No OFFSTREET PARKING ---'Y-_ SPACES REOUBRED i~ • ~~J.T``~' r'3 T'), S csTFfi c c"~1)?G No. of L Dwelliny Units _ _C_o_veied _ _ - _ - Uncovered _ N O T I C E Special Approvals Required Received Not Required `OUNDATION SURVEY SHALL BE SUBMITTED NO LATER THAN FOUR ZONING SAYS AFTER PLACEMENT OF SLAB. HEALTH DEPT. `IS PEr~MIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT. t-iORIZEDISNOTCOMMENCEDWITHIN6MONTHS,ORIFCONSTRUC- s'DIL REPORT j 'OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 6 OTHER (Specify) - `hl ~ HS. _ ` ~I~ EBYCERTIFYTHATIHAVEREADANDEXAMINEDTHISAPPLICA;ION - AND ,<NOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE PERMITS& FEES __CO_DE5 COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Building - + ' Southern Standard' OF A PERjy11T L`OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR y E R t11S1 N Ol~A Y OTHER STATE OR LOCAL LAW REGU- Electric - National Electric' LA T PERFORMANCE OF~OI}ISTR ION. Plumbing O Standard Plumbing "Y J 4 Mechanical ~ • Standard Mechanical` ignature of Contractor or oriz d Agent (Date} Other .J..J -,..~Ci 'O."~1'7_L-4ih' 'Signature of Owner (If Owner Builder) (Date) TOTAL • ~ Ras adopted by ordinance. 0~. m T'ps "~'i'?~yr~[•'~ ~;,~~'a'~` ~ ~ ~.e"! _ C3I`). 1" ~y~?. i ~ (7 THIS APPLICATION, WHEN SIGNED, BECOMES A PERMIT TO START WORK: ~ l~'~ ~ L[~II~,IG ~13F~CaAL Q ~ * 4. 7 Q Q 1..~' l- _ ~___~m - cITY or cAPr cAraAVERAL APPLICATION 1'OR CERTIFICATE OF OCCliPANCY DATE: July 27, 1989 TO's BUILllING OFFICIAL Application is hereby made by the undersigned for a Certificate of Occupancy at the below specified premises as reflected on Building Permit Number 5973 Street .Address : 122 Jefferson Ave. Type and/or Idame Of Building : Fn~ir Tnwnh~mas; San Tnmac ~l; 1 laS II Legal Description : Lot 8: _ San Tomas Vi 1 1 as TT ac raonrrtari in Platbook 36 pale 9 Zoning: C-1 with special exception Special Conditions: none Name of Owner : 4 & W Construction,_Tnr _ _ mailing Address of Owner: ___~,o. B~x2~,Z J Street Address or P. O. Box Cape Canaveral,~FL 32920 City, State and Zip Code (407) 784-4817 Area 'ode and Telephone Number j _ wner's Signatu i;liILDIrdG AND FIRE DEPARTMENT P'ZOV fire Inspector: Building Inspector:. ~ :Building Official: nn Bui ing Permit Number: ~ _I~~ Certificate of Occupancy Number: FINAL INSPECTION CiiECK LIS`1' FOR ISSUANCE OF CERTIFICATE OF OCCUPANCY 1. Architects or Engineers statement that building is built in accordance with approved plans and s~.~ecifications on file with the City. _ 2. Engineers or Architects statement that site construction is in accordance with the approved Site Plan and that all construction has been in compliant with applicable codes. Date 7_L7-89 3. Letter from City Attorney on mainte- ~ Hance of Retention (if applicable). - Date ' 4. Plumbing Final bus ~ j~~ nspe p D t ~f ~ f ? 5. Electrical final 4_..~ 6. Air Conditioning Final ~ j~ Inspe orb a ~ 3, 7. Roof Permit Final ~ ~ Insp c r a `'k~;` ~ 3. Building Permit final 7 3~~~ nspect D e 9 . Dune Crossover (if applicable) _ , n; Ins ~ ~ j~~ ~ at 10 . ence or 6dall Permit Final Insp - Dat 11. Sidewalk/Driveway r _ It'is ~ r D 12. Sewer Connection - ~ , 3/ Ins or a 13 . All debris removed from site nsp D - r r ~ 14. Approved for Electric Service nspec "e i5. Fire Department Fee Paid ~3 oZ Receipt No. Date f' CITY QF CAPE CANAVERAL BUILDING DEPARTMENT Sanitary Sewer Permit FEE $5.00 Date Permit Issued to Address , For one connection at Legal Description Lot Block Subd. Classification Single Dwelling Extra Baths Multiple Dwelling - Class I ( Class II ( ) No. units No. units Hotel or Motel ( )Public Bldg. No. units Trailer Park ( ) Dormitory No. units Assembly Hall Commercial Ilndustrial School W In consideration of permission given do hereby agree to construct said work in compliance with the provisions of the Plumbing Ordinar?te of the City of`Cape Canaveral, Florida. 0 Si2,tf~i d Address ~ Owner Plumber N e> o Building Official o, 84 14 31.-, *1.~1900 g CITY OF CAPE CANAVERAL BUILDING DEPARTMENT Sanitary Sewer Permit FEE $5.00 Date ''nri1 5, 1989 Permit '" + I.6 Issued to Q & W Construction, Ink.. �.n. Box 293 Cape Canaveral, FL Address Jefferson Avent_- For one connection at Legal Description Lot _. Block — Subd. San Tomas I i Classification Permit #5973 2 bedroom Single Dwelling Extra Baths 2 bck.-E'h5 Multiple Dwelling — Class I ( ): Class II No. units No. units Hotel or Motel ( ) Public Bldg. No. units Sewer Impact = $1519.00 Trailer Park ( ) Dormitory Sewer Tap = $25.00 No. units Total Sewer = $1544 .00 Assembly Hall Commercial industrial School In consideration of permission given do hereby agree to construct said work in compliance with the provisions of the Plumbing Ordinance of the City of Cape Canaveral, Florida. C7 <� t` • l i Sii d Address Owner Plur Building Official _/ 3 3 .), ' 11 94 14 31 * L51900 + :t!' "iS'iS•i• .:rrfr .1'! rrlx•. ••!f t •}YCi `tt t r ti5 of,.P' ..r tF� •{ v'd .a r F, tk- v1, :� r !t •sir f°!t 3.r};1.• :•s:..;r.,,.;fE+i;:: 'r, ;'a':''%%s;.{i;,,,,r. L9: f d :.•Il••' ,tk.•' r a ''"�`. r I •�.t•. r r,.:•.•. r r,,t•• tf Y3s. •�'', r sx'i k r.f "'StE r.t 4 �i•.. ..,yE 11 ,1• :y:a ?� 'k r :::� r•••�: Y i r �•k 4 k 'fir A. .r •r� 4 .t3 f a 1•kt- i M1 :.r...r• 3•' r• ...r rr..{'. -•s,.. 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For the following: a ; _•_.:: GT .•. Use Classification Bldg• Permit No, ..tle47 Group Type Construction `v. No. of Units • , _ t �`` j & v Construction . �. Box: . ;� nate . : Owner of Building Address _ .• k D Building Address 122 Jefferson Avenue Locality 'aPe Canaveral, FL a `4 • - j u, Ann Tomas V l l a s II ,.w,z,,. I 4 o ➢ By: y..\ .�,.--••- a ,. • ;n July 28, 198�> Building Official Date: .s ?, • 1' e /1 d w�, f• wy , POST IN A CONSPICUOUS PLACE 4 w.. �'f C••.�':•, ,. • Y FYFt.r',ta'tta.retmetet.t. t.l.'..1...,•.t.retetVtt.t.Jmd.t.tet.t.reteret.ra••e'e,earVF:r.,mmeterdeeederer•••rerereere'aeta.lerdrd,G,ereeteetdetetet.r.;.Yersreei r•t.:•rere,-r,wete.Bradsa.t.erg,.rere.egreererer,rdreteretef•.r � • ,1earVF.vite•6•eeaetete•retV7e46,e. 1, s=.•;: %r • , v ee ee ee m e •,. :: ... z. �� :i %;' a7 j? wt£>; ,�• f' it r •uy. 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Ar9,,vryr. d, d ! . ~1~ r d d A!... vY4rYiY.AdA ! AVryA. r r .r, r , lVr....., r . t . W.l. ryi r .¢i } Per a ~3~ Chit ~f C~~ P C~tt~rttue~ttl !a 'r, a - tal ~t a€~ I ~ Li_ - , { a~.= ~ , i a I ~ t l ~ a ~f. ~F t~tx~l~tPYT~ I1~ {.~1Yt~I~tl~ ~n~ PrttilYi ~~Js" .ate" i'a: ~ r 7 ~P~" 23 ~ I q , ~r~ i ~ This Certificate issued pursuant to the requirements of Section A 103.9 of the Southern Standard a L~.. • i F ;rE ` NL I Building Code certifying that at the time of issuance this structure was in compliance with the ~ ~ ~i`~'f~ ~T: . _ -j>` ~ various ordinances of the Cit re ulatin buildin construction or use. For the following: la = `st`.. F i y g g g ~ ~ w ~ i I Use Classification . ~ Bldg. Permit No. ~ z'~... s f Group Type Construction No. of Units • rE_fr~ ii~s•~:7 s\ - . ss ~ ~ w! Owner of Building Address ~ = i r ~5-: ~ as a 'e 1 ~ £ ~ 5„x. ~ Building Address Locality ~ ~ a k-~' ~ :w•~ ra i u sl r a Building Official Date: i r_..-.. e ! 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F••a F es• • 1' •s ;,.,.:::;.;u77.r•':••:•-5; . 1 f ~.d r.• r. t.:•^• •,,rr q .•"R.x• ,r kc*• d • x~~trx~+,.,...... ir,....•. • - .r.{.-• ,,Ff er~,Z,. y?ti:' ti~l,Fit( j. .S, ..h7(o. „drt•.a.rr •'+'•'::a.qh . 9 ~ 31 3~3 05 *20,00 g~~4~~q~ ~ ~ •°J CITY OF CAPE CANAVERAL ~j BUILDING PERMIT APPLTCATIOr1 ~ 5''' 'HIS IS NOT 11 PERMIT TO ST~1PT WORK _IT IS AN APPLICIITTON ONLY AND WILL BE 'ROCESSED AS SOON AS POSSIBLE. YOU WILL_IIE~C7ILLT:D WIi.L:rl IT IS_RT:hDY,_ ;OMPLETE BELOW APID I~J6URE TIiAT YOU HAVE ON FILE A CURRENT COPY OF THE 'OLLOWING: (HOMEOWNER PERMITS ARE EXEMPT) State License County~License and Competency Card Liability (5100,$300,525 Thousand) and Workman's Compensation Insurance Surety Bond payable to this City (51,000) (Only it City Occu_national license required?_ TYPE OF PERMIT : (BLDG . ELEC . PLUMBI. MECH . ~cOTHEtR PROPERTY OWNER: Q~~ Cl~(VS 1 (~.UC i (~N + ~C PHONE ~c~~r- ~r~ ADDRESS: ~OX 7°~~ ~ ~~PG Cr'1(v~~CCGZ?!,~ ~2~2~ STREET ADDRESS OF JOI3^SITE_ ~~~oi11~33~ `Z~ ~ JC:F~'C-:~ZSG~ 7~iy LEGAL DESCRIPTION: LOT BLOCK ~ SUBDIVISION VC`N~'~`1= ~~L - ~^i OTHER N L ~P.GP w C_.D s S d~zJ ~ Z vh ~ ~ ~f l L~. W S ~1-~~ S E: ~._~-L--- TYPE OF CONSTRUCTION: C. ~ S SIZE OF BUILDING (TOTAL SQ.FT.) ~P~ol~ N0. OF STORIES 2- MAX. OCC. LOAD NO. OF DWELLING UPIITS USE ZONE C- ~ 1,U~ SPF~.t A ~ C XLEPT i o N NO . OF PARKING SPACES ~ C'E2. y ~ t-'C- TYPE OF OWNERSHIP (CHECK ONE): DETACIiED SIPiGLE FAMILY RESIDENCE TOWNHOUSE ~ APARTMENT CONDOMINIUM COMMERCIAL CONTRACTOR ~ v'~_CONS 1 ~'~SC ~ l~N 1 C STATF. LIC. #f C`~C~ ~a~'~~ ~ ADDRESS C30Y•. Zal~ C• C • ~Z~2~ PIIONE#( ELECTRICAL ti~t~OC7 ~~-E~'cV~1 r STATE LIC.#( C-R ©O•Z~~-2 ADDRESS_ `C7S ~.-.lift Cc~~ry C • C- ~ PIiONE#( ~ ~ ~L-~-'Z~ PLUMBING ~I ILl.C2~S"'l L~J.v~ g ~ ti3G-•• STATE LTC.#f ADDRESS /~~60 N L-'w ~3y2?1J S i occ ~ PHONE# ~3~' ~ `ZJ! MECHANICAL V 6' t1~C~1 C- ~ ~~Z- STATE LIC . ~ C(~ ~ ~S •-ADDRESS ~J~X 1 ~ ~2- ~ G~C~r'1 ~Gl_.( PHONE#k ~ n3-94~n2 ``;'OTHER STATE LIC.## 'ADDRESS PHONE#k NATURE OF WORK TO BE DONE : ~ f° +N S•r 2 ~ LT ~ N SCy. U N ~T~ ~ ~ VALUATION OF WORK/CONTRACT: $ D~~ ~ ~ NOTE: This application is valid for 15 working days after which time, unless a permit has been drawn, this form and all attached material will he destroyed. Date: ~ Signed• Licensee, Agent of Record or Owner ~ ~ rr. ~ ~ ~ \J ~ ~ I Q I' _ - V-- - - ~4 « ~ _ _ q ~ ~_~a ~ _ ~ ~ _ _ ~ ~ ~ ~ J C~. - ~ -r - _ - ~ ~ ~ ~ ~ ~ ~.9 _ - - _ _ ~ ~ _ o c~ _ ~ _ _ - 1 ~ U ~ o _ _ - - ~ _ _ _ _ ~ s ~ ~ ~ - _ _ _ _ _ _ _ c i, 1 ~ ~ ~ ~ ~n ~ r~ m ~ ~ oo ~ f~- ~ t --cam - - Insurance Surety Bond City License State License Work for a lessee, renter, manager, agent must have approval of legal owner of record. Homeowners, condominiums, townhouses or others*, with an association control, architecture and building criteria, must have approval signed by the governing body. * Others is to include covenants, conditions and restrictions as recorded on deed; however, this office is responsible only for obtaining compliance with the Zoning Ordinance.