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Building Permit App
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WORK TO BE DONE
Pi d!F �� BUILDING
1 VALUATION
BUILDING PERMIT
NUMBER OF STORIES 1 FEE
NEW DEMOLISH I PLUMBING
ElADD. g PERMIT FEE
ElHEAT & GAS LINE
ALTER � RESIDENTIAL NUMBER OF PERMIT FEE
DWELLING DEMOLITION
REPAIR NON-RESIDENTIAL UNITS 6 PERMIT FEE
8 AMOUNT DUE
I hereby acknowledge that I have read this application; thaJNED
formation given Is correct; and that I am the owner, or the dulATTENTION
iced agent of the Owner, I agree to comply with city and state lTHIS PERMIT
IaUn6 construction; aM In doing the work authorized thereby, AUTBOA7ZE8
w111 be employed la vlolatfon of the Labor Code of the State of WOpp THE
relating to Workmens Compensation Insurance. WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR
SIGNATURE (OWNER OR AOENT) DATE BIOINSPECTION
DEPARTMENT
CITY OF
LOT PLAN CHECIC & APPROVED I EDIIIOND$
PR 0-1107
FILE