HomeMy WebLinkAbout2535 Jefferson St; ; 77-2348; PermitMODfi:L NO.-----------
BUILDING PERMIT APPLICATION
Applicant to complete numbered spaces only.
7
8 Class of work: ONEW 0 ADDITION
9 Describe work :
10 Change of use from
Change of use to
tOsrt ATTACHED SHCETI
ASSESSOR "S
PARCEL NUMBER
BOOK PAGE PAR.
STATE LIC. NO, CITY LIC, NO.
&.-It.NCH
NO. BATHS
11 Valuation of work:$ PLAN CHECK FEE s~ -PERMIT FEE s -0-
~S_P_E_C_I_A_L_C_O_N_D_I_T_IO_N_S_: __________________ ~Type ot
Const.
1------------------------------~ s,ze of Bldg. (Total) Sq. Ft.
NOTICE
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB·
ING, HEATING, VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM·
MENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT, THE GRANTING OF A P T DOES NOT PRESUME TO GIVE AUTHORITY TO VI CANCEL THE PROVISIONS OF ANY OTHER STAT OR AL LA REGULATING CON. RUCTION OR THE PER ONSTRUCTIDN.
SIGNATU"E Or OWN£" tr OWN( .. IUILDE•O DATE)
Special Approvals
PLANNING DEPT.
HEALTH DEPT.
FIRE DEPT
SOIL REPORT
OTHER (Specify)
ENGINEERING DEPT.
WATER DEPT.
Occupancy
Group
No. of
Stories
use
Zone
MICRO FILM FEE
Max.
0cc. Load
Fore Sprinklers
Required DYes DNo
OFFSTREET PARKING SPACES·
No.
Covered
Required
Sq. Ft.
Received
No. Open
Not Required
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
TOTAL FEES$ ________ _