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Bt�ilding
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BUBMTT A COP'Y OF STATE LYC�1vSE �� (�. �����_ EXp DATE '� � l� �� �►
YOUR S'�AT� LIC�NSE +�DRESS:�_�[..� � �'6� �� �I� ^ � $TAT��7jp
W�T�TAFFLICAT10T1 PHON� � �� u�,�.� --�—��
�'1tOPL,�2'i'y Titp'E .�SR�TGT.� RAMILY/bC�W COt�STRUCTTOt�T STZE
C3 TWO FAMTLY/N$'UV' CONST1t�TCTItiN 3TORTES
PE22�VIIT TY�E d ADD�1'ION Ct r:a u e ratc�cicrcn b,_...._ __..__
C7 gASEMENT F�NTSii p Rppg �
❑ D�CK ❑ SIl7Tt�TG
T�PE
D$SCRT$� WOItK BEIi�C'r
N� OF SQ1U ARES ^, ❑�OUS& ONT.Y
_ ❑ Y-IOUSE �& GARt1G�
� ❑ ATTACT�D GAIZp,CrE
pttOP4SEb 3IZfi: ❑ D�TA,CHED GAR.AGE
pltC}P03E.0 iiSltiHT; �--
C7 L}ItAIN T7T.E
❑ O�ER
'�TDTH
SID;NG�
L71(inyl C73of�5t
❑ nEuminum ❑ �'rim
o AtEter
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IN��XI�C OFHNING9 �Yes C3No LQCATION OF VAINI]OWS
41t FOR NEW OPEtdTN'GS-D&SCTtiHB SI7.� OF
OpEiVING CHANGE3 4$ �-- ^.--
T'P1�E OF WTNDpW TO B� INS�TAT.LE.D �� 1��� p� �yI�WS �
ALL 17'EES AR� BA$ED p1� V'ALUAxYON, INCT.UDING THE C4ST U�'
iUSING TH� i997 U.B.� FEE S��DUx,E)
TOT,A,Y, JOB 'VALUA�,iON � �/_S L3� nr•.•Trn . ,.,...
Permit �'oa
Pian 1Zeview
Fice Suroharga
Surcharge
iicense S�chsrge
sAG Charge
Curb CuI Escrpw
Lrosion Control
Park Fec
3et�ver Main Gharge
To#�1 nue
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BASEMEtJ'T RSMOD&Y,�NCO ^�Lk,(„�
1. Existing Flaor Pl�n
2. Praposed floor plap
3. List of,�rueturai members to be used
FOitNEW CON'STRLJCTYpN iN�Li]TaTNG pE(;�g,
.4L1]DTT'_. [ONS...g�,pOTtCH S S�l7BM1T;
1, Siu FIan/Surve� s�wingthe exis�ii�g sUUCtures
and propostd pro�cct.
2. 9tiaa sets af cotRwctiatl plans
3• Encrgy Caiculations
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� � See Back Page for �ee Sck�r,dule
� 65°/n of $uilding permit Fet
� -��� ,OOt times the tatal job valuation
.0005 x Permit V'slustipn Minimurn $.50
$ C �� $5.00 (SCate Licensed Res;dantial Contractors)
� $I 550 per SAC LJnit (Flana to MWCC for deeorminatio�)
$ ft+6�= fix$22 =$
� $d50 Conservation �tan Revievv �—�
� Ftc Deterrnincd by Engir�eet�ing
�' Agretment necsasary ( ) Non Nocess$ty� ( )
� h2ake checks payable to; City o1' p'ridtev Atthr
'CHT$ 13 AN APPLrCATION xOR A PERA�tiT-MD'(' VALiD L�TpIt PRQCESSSD
I hereby apply for a building perinit arld I aclrnovvledge th�t the itiformation a6ove is coraploYs and aecurate; that the work wilE be in
eonform�r�ce witY� t}ae ordina�ces and codes of tl�e Ciry o£Fridle� and vvirh the Aq;r�nQSata Co�estrvctiaz� Codes; thet I understand this is not a
permit but oniy en application far a permit and �ork is nat io seart without a permit; that the wark wilt ba in aceordar�ce with th,e approved
plan ira thc case of all work w' h requires revi w and ap ro 1 of plans.
sIC�iNATUR$ O� APPLICANT �
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