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AF - 43185�� I� City of Fridley, 1Vlirm.. B�TILDING PERIVIIT �Date: ... ----'-:..�. ___.'- _ ...._ .—..._—.___---...____..._. Owner: ..--•-- - ---�--------._.%_..._.�.�.�....� _....._. .------- - ---- Builder Address -----_..--------.......__..�........._._.._...._...—.._..�.. _.___ Addres.s 1�T° 4436 � LOCATIONi OF BUILDING " No. ...r.......��.._.... S,�t ......... .. . ._.._._ .... ...._ ....._.....�i�_.�1._.._...._.... p of �t .__.._........__........... .._............ �...._...._..._._...._ Lot .......... °..�.. ...........-....... Block -------...i.....- �- ..... - .. ddition or Sub-Division . _ .. ... .. . ... .-�- --..... _........_....... .--- .... ... ..��/ '�J � �� � ,. Corner Lot ................... �............ Inside Lot ....._.. ��......_.... Setback .�...s�...---.........---�--.. Sideyard ...._........�.�..._......................._ B� --.._......._. Sewer IIevation .--�--...--�....�...�...---------�-�------�--�--�----..._ .............---•�---- Foundation IIevation .........-�� -�--�~��d---�•--��.--------..._..._.._...._.. DESCRIPTIOIV OF �UILDING To Used : i' � .• /- - � f -� ... ... ----- ............._.._. -- - .... Froat - _.. Depth ...�_;�.--- Height ...�..�.... Sq. F`t. .. .. ... .. . 6r��=°�"--- --- �-..g.......... Front �e ..:.......... Depth ...r�c... � . Height ._/ �.... Sq. F� ��... . 1j�pe Construction _---1..�. . ....... .. ._ . . ..... Est Cost �. `��. .. f-.�� ��. �^To be Completed ... In consideration of the issuance to me of a permit to cons e building described the proposed work in accordance with the description above � forth and jn comp�anc� ordinances of ttie city of Fridley. f/ �/ In considera.tion of the paymettt of a fee of �.. �.., �mit is hereby granted Cu. F� ��� Cu.Ft. • ....................... e, I agree to do all provisions of ..___.._._.__._..._____._.._._...___....... to construct the building or addition as described above. This peimit is granted upon the express condition that the person to whom it is granted and his agents, employees aad workmen, in all work done in, around and upon said building, or any gart thereof, shall conform in a]1 respects to the ordinances of Fridley, Minnesota regarding location, construction, alieration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon viola ' of any of the provisions of said ordinanc�s. ��a�� % � � � Inspector NOTICE: This permR does not eover the aonstructfon, installafion for wfring, plumbing, gas heafing, sewer or wafer. Be sure to see the Building Inspeeior for separate permifs for these items. 4 -�/ � ��� e � � �� . � � � � �o+ � C a � � . � 0 � °� �p a � � LJ. � d � .� E U � � �� � •,r . 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Room � Length �� Width .� Height �' P FI.� ` Room Lengtlt Width Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area �Vidth HelBht No. ot Llneal tt. Area Wldth Height No. o[ Lfaeal tL Area No. o[ pane ot pane lighta ot crack ep. ft. No. ot Dane o[ pane IfBbte ot crack eQ. it. � !� .'� ��''� iP G? !�. , � ��.1. . � .� r`� _ � * r Infiltration '�' '� ��� Glasa � �"' Exp. wall "�,� ° Net exp. wall �' � �' {� "� h �'s Int. wall Ceiling Floor � � `I'otal Btu. " � Required sq. ft. E.D.R. or aq. ina. W.A. Leader area Ft.� ;�''. .�'� Room � Length �' Width Height Windows and Doora—Crackage and Area Wldth Helsdt No. ot Llaeal tt. Ares Na. ot Dane ot pene lighte ot crack ep. it. � �� � , � Coef. Btu In6ltration �,� Glaaa ` Esp. wall � °' Net exp. wall ` Int. wall Ceiling Floor ' 1'otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area � Fi. '� Room � Length -';� � Width Windows and Doora--Crackage and Area Width Helght No. ot L1nea1 tL. Area No. at yane ot Dane 116bts o[ crack sp. tt. Btu lnfiltration I �° °" Glaaa a�' � � �p. wau Net eap. wall ° � Int. wall � Ceiling �.'� Floor � � Tbtal Btu. Required aq. ft. E.D.R. or sq. ina. Q(.A. L.eader atea Bhl � Infiltratioa Calass �. Wau Net eap. wall Int. wall Ceiling Floor Total Btu. ft. E.D.R. or aq. ins. WA. I.eader arxa Windows and� Doora--Crackage ana Area Wldth BelBht No. of Llneal tt. Area No. of yane of pane llghts of crack eQ. [t. � '� N"§ �" "�' � � Infiltration � Glass �p.,�►au Net ezp. wall Int. wall I Ceiling � a Floor � � . `� Total Btu. ' � � I Required sq. it. E.D.R. or sq. ins. W.A. l.eader area I �.� ��_ �m � ��, Widch Hei�ht Windowa and Doors—Crackage and Area Wfdth Height No. of Lineal it. Ares No. o! pane of pane IIBb� ot crack sa. t4 � � Coef. Btu In6ltration =� � Glaas E�. wall � Nec exp. wall Int. wall Ceiling Floor 'fotal Btu. ll Required aq. k. E.D.R. or sq. u►s. WA. L.eader area I . n.� �,.� - - HEAT LOSS CALCULATIONS DEPARTMENT Weatherstrips A.S.H.V.E, Construction I� Guide Windows I Doors Reference Out. Wall Int. Wall C,eiling Yes—No Yes—No 19— Fl.�,�.��; E Room � Length d�� �Width f� Height Windows and Doors—Crackage and Area tVidth Helght No. o[ Llneal L. Area No. ot Dane ot Dane. lighte of crack eq. ft. � � � � P '� �'�• Coef. Btu Inhltration �. � �° ° ,�"� Glaaa %' � � ? � o� Eap. wall "? �' °�,� Net exp. wall ;s �` r,L� � � � /'�' ' �: Int. wall Ceiling � ca � . � �,, Floor / °�'4L.�,' ° a' �+ ,�� � .� 7'otal Btu. � � �',�; Required sq. ft. E.D.R. or aq. ina. W.A. l.eader area Fl.� -.�� . Room � Length � Width � Windows aad Doora—Crackage and Area Width Hefght No. o[ Llneal tt. Area No. of yane ot pane iisncs ot crack ra. ft � � In6ltration Glasa F�cp, wa� Nee ezp. wall Iat. wall Ceiling Floor Tocal Btu. Height Coef. � Btu Required sq. ft. E.D.IZ. or aq. ina. W.A. l.eader area Fl. 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O m �p C � � � � c o � � � � .—'� � � 0 E� o� U r . o� � � O Z � � _ a, � z m � F= a`, � m o�D � � \ a � � ; '�1 � � � .L � i � � � � m � O _ . � � � � '�� � 1J ^ � t� ° ,I " � � c � O Z d � � 0 C � t rn J �'o a m Ca � a o � a. pf fn Q Z � Z 0 U uT. �w 9 a H � �w U O Z w� ❑ � � Y �-- m � j U O J n' W � � � 0 � � � �a � � � v N � /{I d G �' . O � Q N � c n. "`c � O ,.. � O � � � � � c 0 �� � o € p aa U � � a sue�etT PERMI City of Fridley 2 919 AT TME TOP OF TME TWINS g � I L D I N� P E R M I T r ; � RECEIPT NO. � ; v ����_ COMMUNITY DEVEIOPMENT DIV. ��� r � � PROTEC7IVE INSPECTION SEC. � . , � j �'�'1 � CITY HALL FRIOLEr 33��2 NUTABEP NEV D�T6 PAGE Oi APOqOVED 8Y �'""'�" �'' 612-571-3460 910-Ft5 4/13/99 / / 10B ADDRESS 140 Craig Way NE t LEGAL �07 NO. BLOCK TRACT Oii AODITION SEE ATTACHED oesca. 3 1 Pearson's Craigwa Estates SHEET 2 PfiOPERTYOWNER MAILADDR�S$ ZIP PMONE Neal & Lori Robinson 140 Crai Wa NE 571-7716 3 CONTRACTOF MAIL ADDRESS ZIP PMONE LICENSE NO Same a ApCNITECT OR DESIGNER MA1 ADDRESS ZIP PMONE UCENSE NO. 5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW Q ADDITION ❑ ALTERATIpN � REPAIR O MOVE O REMOVE 8 DESCRIBE WOfiK Reroof House & Garage (28 Sq) Tear—off 9 CHAN(3E OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORR HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. SEPARATE PERMITS ARE REOUIRED FOF ELECTRICAL, PLUMBING. MEATINp, TYP� OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO VENTILATING OR AIF CONDITIONING THIS PEiiM1T BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SQ. FT CU FT. AUTMORIZED IS NOT COMMENCED VyITHIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDEO OR ABANOONEO fOR A PER100 OF 1�0 DAYS AJ ANY TIME AfTER WORK IS COMMENCEO. NO DWLG. UNITS OFFSTFEET PAFKING I HEREBY CEHTIFV 7HAT I MAVE READ AND EXAMIN�O THIS APPLICA71pN 1 STALLS GARAGES AND KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAW$ yp�UATION SUFTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL QE GOMPUED WITH WMETHER SPECIFIED HEREIN OR NOT. TNE GRANTING OF A PERMIT �2�399 $1.ZO OOES NOT PRESUME GIVE AUTHORITV TO VIOLATE OR CANCEL TME pEqM17 FEE SAC CMARGE PROVISIONS OF AN T STATE AL LAW REGULA7 NG CON- STRUCTI OR T E RMANC ONSTRUCT�ON �74.7.5 Fire S�'i �2.40 �" PLAN CHECK fEE TOTA� FEE � . % $78.35 S�GNSt A CON'AA OA uiHOA�ZEDSGENi �0 E WMEN PROPE VALIOATED 7HIS IS YOUR PERMIT c /� S�G A1UAE O� OWNEA ��F OWNEA BWLDEA� �O�TE� � BlD ��a5o � qciE s s ' NEW [ ] ADDN [ ] �-� I l ConstructionAddress : Legal Description: Owner Name & Address: CITY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION f % 0 � Effective 1 / 1 /99 ��X ��� � Tel. �/ �r,%��' , Contractor: /� �; MN LICENSE #, , Address: LIVING AREA: GARAGE AREA: DECK AREA: OTI�R: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground Tel. # Sq. Ft. Sq. Ft. Sq. Ft. o�$ � r�d�'e5 Construction T e: ''� ''�e—��� Estimated Cost: $ � 3�� yp �� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft =/, ..Ft x� _ _$ DATE: APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY do � Tel. ra, Jp'I�� �%% r $ ��/ � s Fee Schedule on Reverse Side $ �. �-1 0 .001 of Pernut Valuation (1/lOth%) $ / . 2 0 $.50/$1,000 Valuation $ $1050 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] � `�.35� BUII.DING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing pernuts for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge} $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereoi, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb 5treets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50. Alternate "B°: Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $23.25. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. N O N • a �� �. c ' cv � . . C O ' .- � . > � U w W ' Z 0 H N W J V ~ W zo >c �Z za J y � W l ��� � � �C7 N Z H Z m a Z O =0 � C F' aZ �n o Z � OC aa W Z �a z a� �Q O� W O� ~ W V � J a z a o a � � O = 1-- � W Nz � Z a� N . v� Q �' � � i � � � � � Z M u..�g^ �� � T� � � � c�..�..M�� U�ti� � �► :_ I .i 0 w � _ C9 Z � J � m � C � \ .� N � �� � L -a _ �O Uy �� � ., 3 � � ��_ . � � � a � �.�•-^ �. a � . - : � m � � � t . . ' W ' � R . - _ � '`'' � i. („ . . 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ADDRESS/ �O _% OCCUPANT / �u� HEAT LOSS DATE HTG. INST. R'—G� °OZ SOLD BY 1 A. C� Elecvical Work By -P TYPE OF HEAT GA FA HW S AM SPACE HTR. MAKE t�a�i f Q 1� GAS DESIGN Model t� � — � Serial �1 `Z �Z Q3 � INPUT ��. �� � - - L.W. Cut Off Presaure � Peroent COZ Input CFH > Percent OZ � Stack Temp. � L � Peraent CO o HOUSE H�ATING TEST RECORD APT. FLOOR CRY''�� SUBURB OYVNER INSTALLED BY `�l C.� �6 �'C'i Gas Line By `� UNIT HTR. OTHER CONVERSION Vent Size � CO KIND OF LINE �.1 � SIZE NONE E3f8ff IiOQd 'E' --- --Re9 er Filters Size �� �7 t�( Number � Chimney Location Inside Outside Chimney Construction K r-t Smoke Bomb wring Draft TestTaa ) Door Pressure Lightlng Inst. �� Date Tested � � ° �Z Company Testlng � �v-•Q °t'[s Name of Tester Pressure Percent CO2 Input CFH Percent Oz Stack Temp. 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ADDRES'S � s1�,�D�ss I Pa,� �,► P � . THIS APPLICANT IS: O OWNE+R PROPERTY Nq�: ��' OWNER/ nDDRESS:� TENANT CONTRACTOR coMpqx�N,�: Sharp Heating & A.C. SUBMIT A COPY OF CONTACT PERSON: FlOyd JOSW3,Ck � YOUR STATE STATE LICENSE # E}� DATE LICENSE WTI'H ,�D�s: 7221 IIniversity Ave�. N. E. � Fridiey sTAr� 1MIl�T�, 55432 A.PPLICATION pHONE_763-572-045 FAX • • . ' PERNIIT TYPE TYPE OF WORK: �SINGLE FANIILY ❑ TWO FAMILY � NEW �REPLACE1vIENT DETAILED DESCRIPTION OF WORK ❑ TOWNfiOUSE ❑ ALTER�TION/REMODEL. PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of t6e total �cost up �o $50O:n0; whichever is .greater, for.the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should refleCt only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = � FOR PROJECTS Wf�RE LqgQR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXf1JRE� g}(CEPT WI3�RE.NOTED. NUMBER OF EACH BELOW) �, . FIXTURES: (WDICAT$ TOTAL Equipment Installed ' MFC'i: MODEL: ' SIZFJB•fU • MFG: MODEL: SIZFJBTU �`'��� MODEL: SIZE7BI.0 A/C 525.00 _FIREpLACE (GASj $15.00 _GAS ReWGFJOVEN $10.00 _,AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 _BOILER $35.00 _FURTIACE $35.00 �W Q!°`S ��L $10.00 _CHIMNEY LTNER $]0.00 _GAS DRYER $10.00 —C'� �T �$10.00 _DUCT WORK S10.00 GAS PIPINCi $10.Q0 . PQOL HEATER 535.00 . -- VEI�TTII.ATOR $15.00 Permit Fee $ ' Number of fixtures �$tp,pp x$10.00 =$ Surcharge $ .50 Number�offixtur.es TOTAL DUE $ Ca: $15.00 x $15.00 = $ . Number of fixtures @ $25.00 � X $25.00 = $ Number of fixtures @ $3S:OU x $35.00 = $ State Surcharge = $ 50 Total = $ .,�, p THIS IS AN APPLICATION FOR A PERNIIT NOT VALID UNTII, pRpCESSm ' I hereby apply for a building permit and I acknowledge that the information above. is com lete :and acc conformance with the ordinances and �odes of the City of Fridley and with the Minnesota•CoiLstruction � d�es�; that�understandlth s s not a permit but only an ap ication for a permit and work is not to start without a pertnit; tha t t he wor k wi l l be in accordance w�th tMe approve d p lan in the case of work w i r es review and approval of plans. SIGNATUREOFAPPLICANf . PRIN1'NAME__ V��Illfj �.�����p,� .,,,,,, ��,L�_/�Q City of Fridley Suilding Inspectians Department 6431 University Avenue NE, Fridley, MN 55432 � 763-572 3604 FAX: 763-502-4977 Building BUILDING Permit No.: `�CaZ�� !I �I?�� Inspections RESIDENTIAL APPLICATION ived B:�' C� � a 763—s�2-3604 CITY OF FRIDLEY ������ � 010 763-502-4977 FAX �FE�.r�v�,_,_�olo DATE � °' S �!' ._ �-� s � YOUR &MAIL ADDRESS STfEADDRFSS � y(i �1(/�I4:� 4�4�°� j�l (:- F,n.�o] ,�='�/ G1i1,fJ THIS APPLICANf IS: ❑ OWNER �CONTRACTOR PROPERTY OWNER/ NnME: I�l �t'�(r } I...of!'-� �o �'�.trl �c� TENANT nnn�ss: R�f c� C►�-v9.+ �, u�c�-i IU t crrY 1�'--aC�L.t� STATE WW Z[P h a�"`-�� Z rxor�: %!�3 -- $`7 I — ?7 ) (c CONTRACTOR NAME: v1 S GFd N.�.� � � "ez+•! �, �,t GT.+��3 SUBMIT A COPY OF STATE LICENSE # iVl�'�) YOUR STATE LICENSE �`�Z `� EXP DATE � 3 i ?�- il ANDCERTIFICATEOF ADDRESS: �►ii�F't�V`�� �Ei0L�5 �.�i? (a��.e�l��/` IW��Y 1� STATE�ZIP ��O`�'3 Il�TSURANCE PHONE ' 7�JG' - I'Z7�3 , FAX ,�SI�— 4� L=-- �7l0`� PROPERTY TYPE �SINGLE FAMII,Y/NEW CONSTRUCPION SIZE ❑ TWO FAMII.Y/AiEW CONSTRUCTION STORIES PERNIIT TYPE � �DI1'ION ❑ G�,itnGFSSxEn �wIlVnowS ❑ BASII�IIIVT FINISH �ROOF O DRAIN TII,E � DECK d�'SIDING {i�OTHIIt j�N5G1Y+� SC�se-If1T6 %�iiC�c�ta=�� Da(��,''tj ❑ SWA�IIvIING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCI'ION ❑ ADDITION �MAIl�TENANCF/REPAIR O ODII.ING DFSCRIBE WORK BIING DONE: IUG�" ��'� ��� Q�`'�`�i ��-c Y N� 5,.� �-��l � w� ��r-nw t� v.�; � SIZE OF IMPROVEII�IIIVT LINGTH �VVIDTH HIIGHT SQ FI' RQOFING f C ❑ HOUSE ONLY �- BASII�NT REMODII.ING SUBMIT: NUMBER OF SQUARES �� '�HOUSE 6c GARAGE 1. Existin� Floor Plan GARAGES � ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSID SIZE: ❑ DETACHID GARAGE 3. List of structu�al members to be used PROPOSID HIIGHT: SIDING FOR NEW CONSTRUCI'ION INCLUDING DECKS, O Vuryl ��grt ADDITiONS_ & PO�tCHES SUBMIT: ❑ Aluminum � Trim 1. Site Plan/Survey showing the existing struetures l� pther� � g� and ProP�sed Pro,j�t- 2. Two sets of construction plans wnvnows 3. Energy Calculationg IN EXIS1'ING OPININGS �3'es ONo LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND OR FOR N�'W OPININGS-DESCRIBE SIZE OF MANUFACfURE STICKER ON WIIVDOW. OPENING CHANGES & Ll`I^a �1w.��t ✓� i�it i r'( 5 TYPE OF WINDOW TO BE INSTALLID ✓ic�.'v' v� N�IMBER oF WINDOWS ��' ALL NL�'L�'S AKL BASI�'.11 UN VALUA'1'IUN, llV(:LUll1NG THE COST OF LABOR AND MATERIALS: �IJSIW . 77;� � nn� iT u n t�EE SCHEDULE) JOB VALUATION $ Q,�� n(�li <�.r� �� �� " OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Chazge Curb Ctit Escrow Erosion Control Park Fee Sewer Main Charge Tofal Dae $ $ $ $ S� Back Page for Fee Schedule 65% of Building Permit Fee .(}O1 times the total job valuation .ODOS x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractots) $2100 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Ag�ment necessary ( ) Non Necessary ( ) Muke ch�ks pavable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PIItMIT-NOT VALID UNTIL PROCESSID I hereby apply for a building pernut and I aclmowledge that the information above is complete and accurate; that the work will be in conformance with the ordinan and c�es o City of Fridley and with the Minnesota Construction Codes; that I understand this is not a pemut but only an applir,�ti ork is not to start without a permit on site; that the work will be in accordance with the approv� plan in tlie case of 1 w" review and approval of L�� SIGNATURE OF APPLICANI' PRIIVT NAME�, °/`�"��C,�J � DATE ���v 7-� I� APPR(1VAi.1NCPFl`T(1R CT(.NATfiRF FOR PLUMBING. ELECTRICAL AND MECHANICAL WORK