BUILDING PERMIT APPLICATION  Jurisdiction of  Applicant to complete numbered spaces only.  JOB ADDRESS LEGAL LOT NO. DESCR. OWNER CONTRACTOR ARCHITECT OR DESIGNER ENGINEER 6 LENDER 7 USE OF BUILDING 8 Class of Work: 9 Describe Work: 10 Change of use from Change of use to 11 Valuation of Work: $ SPECIAL CONDITIONS:  BUK  TRACT MAIL ADDRESS MAIL ADDRESS MAIL ADDRESS MAIL ADDRESS MAIL ADDRESS  D SEE ATTACHED SHEET)  ZIP PHONE PHONE PHONE  PHONE LICENSE NO. LICENSE NO. LICENSE NO. BRANCH  NEW  ADDITION  ALTERATION  REPAIR  MOVE  REMOVE  PLAN CHECK FEE Type of Const. Size of Bldg. (Total) Sq. Ft. Fire No. of Dwelling Units Special Approvals Required HEATH DEPT. FIRE DEPT. OTHER (Specify)  PERMIT FEE  Occupancy Group No. of Stories Use Zone OFFSTREET PARKING SPACES: Covered  Division Max. Occ. Load Fire Sprinklers Required Yes n No Uncovered Not Required  APPLICATION ACCEPTED BY PLANS CHECKED BY  APPROVED FOR ISSUANCE BY Zone  NOTICE  Recieved  SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, ZONING VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTED OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS 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 COMPILED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF FOOTER A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATER OR LOCAL LAW REGU- FOUNDATION LATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. FRAMING  COMMENCED.  INSPECTIONS  FINAL  SIGNATURE OF CONTRACTOR OR AUTIORZED AGENT SIGNATUE OF  DATE DATE CASH  BUIDER  WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT  PLAN CHECK VALDIATION CK. M.O.  PERMIT VALIDATION CK.  M.O.  CASH