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$uildi�g B��D�I�IC.i Pertnit No:: ,� C 2 c,� �
I�spectic�ns RE�I1���TTIA�., APPLICA►TIQN �ec�iye� By:
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PROPERTY UV
TENANT
SUBMIT A COPY OF
YOUR S?A'C'E i,ICENSG
�:ND CERTCF(G:ATE OF
INSUR�NCE
PROPER'�'Y TYPE
YOf1R �.N.A1L AD�iESS 7�'� f� J� .^.l,,,.�, {:sca r+. tc� �^r �r� t�' o r►Q ��lror�ca.,^`: »e^
�erview 1"�rr��f� ���I.� _
ct owm�at ;�c�r�'rw�c•ro�t
�. a� 1 5 1 i n�� r- !
�SC• ln���L� �;�/'a rt u�ir�e�r T r. �.r _ t`ITV t- �:�I�a �� STATF Mri 21P �J��3+o�
PFI�IvE:
ST�TE LfCENSE
S1TiGLE FAMIL
'f"UI'O FAMiLYIl'
[7 BRSEh��NT F1NI5EI CJ'
� DE�K ,%�
CEI2T N[JMBER�
C1TY�:++
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CJ S WIMMING PC)RL
Tlf`$E QF WURK: 0[3ElNH(}M�C�NSTRUCTI+6N ❑ ADDIiT0�1
Mr1fNTEtifANCC�tEPAIR ; i O REMODELIN!G
p � .
DESCRIBE WOR1C B�TNG DONG: f�t.°,i+^E�Yr� Gt � . 'l�r • � �C %�'t � ^. � � .�. ^:� + .`'• '• W i
�
S12EOF tMPROVEhiENT LEM1iGTH WTDTH
F[N ❑ HOUS€ OIYLY _
1+lUM$ER OF SQUAi�ES O HOUS� & GAR4G E
GAi2AGFS ❑ ATT,'�CH�1?CtARACrE
PROiadSE� SIZE`. C7 I3ETACHEU GARAt'iE
PROAOSCD FfElGHT:
�,�:
OSo�i SIDI�'�[G/SPFEfTlFA5C[A
CI Trim REMQ�ITED? 0 Y�S Cl N�
0 Fascia
tivfyocw� �
IN EXfS1'i1VGOPENlT1GS CJYes E]Na C.00ATfUN OF WTNDOW$
OR F(?R NEW OPE'V�1GS-DE5CR[HE SIZE E3F
OpENiyG CliANG�S 8a
ALL �+'EES ARE B:4SED UN VALUATION, INGZUDING TEiE COST (OF
(i;SIIYG THE I997 [1.B.0 FEE SCHEDULE)
.�[1R VA1.i:ATI{�N T. ��i � I. � OCCUI',
Perivit �ee
Plan Review
Fire Sureharge
Surcharge
License Surcharge
SAC Charge
Carb Cut Escrow
Erosion Control
Park Fee
Sewer Mtain Charge
Totai Dnc
S�
:�
h! wJU�G'A $ �f�tn�
BA S�RF,I�QDEi INCr SUt3M[T-
t. ExistingFlaorPlan
2. Proposoc! floor plan
3. List of strtt�etu[s] members to be used
FQR hFE1�V GONS1RUCt10N NCLUD[NG QECKS,
ADClI'yT ' TIS_ 8c PORCI�F�S,�$Mt'C:
l. Site PfanlSurv�y shvwzng the e?usting stn�wres
and proposcd project:
2. Twro sets of crnstn�.tion �rlans
3. Ene�y� Caltvlaiions
FOR WIND(7WS - PRf)V1DE t1-YALUE AND
MANiJFACTt7R� SfICKER RN WTNDC)UW.
� r� L� �� See $ack i'age far Fee Sch�dul�
$ ,� 65°�'0 of Building Permit Fee
$ .t�tlt times #he total�ob vaivarion
$ 5 .000� x F�rmit Valua.tian Minirnum ar .�0
� 360 �S.OQ (State LicensQd Resitlential Contractors)
$ $2365 per SAC tJnit (7'lans to MWCC for deteeminaiion}
� ft+fift= ftx$25=$
� $454 Consen�ation Plan Review
�; Fee Determimed by Engineering
� Agreement necessarp (} l�ion Necessar}' i)
"THIS IS AN APPLiC A'f'TLTN �'OR A PE[t3uTiT-N�T V�C.II? UiYTIi. PRCICESSED
I hereby appty far a building permit and I ackno�vledge that ttae information above is complebe and ace,�:rate; that the work will be in
co�forniance with the ordinances and a�des of the Gity of FricFley and w�ith the Elrlic�nesata Car�struction Codes; that t understand this is not a
permit but only an appliration for a permit and w�ork is not tc� start withaut a permit on site; that the work will be irt accordance with tf�e
ap�roved plan in the case of a c wh�ch reyuires review and approvai ofplans.
SIGNATI�RE OF APPLIGANT�;is�� " PRINT NAIVIE�r. r,r �}.. �,c i �-u• QATE +�.' ��' i+�