PRE 2010 DOCSN? 172
Village of Fridley, Minn.
Office of INSPECTOR OF BUILDINGS
Architect
Builder,*`��,
Fridley, Minn., 19
LOCATION OF BUILDING
No. ��� Street �LLPart of Lot
Lot Block _ Addition or Sub -Division"
DESCRIPTIONO F BUILDING
Front Depth Height � Stories Man
ner of Construction
A
To be used as �'�� a � ��'"��-�^��`� To be completeEstimated Cost
'pl S' Ste' �,�.'? n* h '-yo- "'°j✓*""�s t -fir, r`f'.�:�. .�' �-"+:'�;�'� �� �f ''��e:-. x'4.5 f. _, � �.7 ���� .''m,��n 'S, '�
Permit is
the buildingdescribed in the above statement. This permit is granted
upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all
the work done in, around and upon said `building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limits, and this permit may be revoked at any time up04,, violation of any of the provisions of said
ordinances. 7
.; ! Inspector of Buildings.
AGREEMENT AND. SWORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permit, I hereby agree to do the proposed work in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true as therein stated.
Subscribed and sworn to
before meat Fridley,
, Minnesota�
this ----�
,
day of i ,. A.D. 19
City of Fridley, Minn..
6431 Univ�ersity Ave. -N. E., Minneapolis, Minn. 55432
j
September 14, 1972
Burton C. Ellis
Builder
Address ___. 115 Talmadge Way Address
Same
Same
LOCATION OF BUILDING
,,To. 115 ^� Street Talmadge Way N.E. . Part of Lot
Lot ._.._2 3 __ Block 1 v______... Addition or Sub -Division Elwell ' s River Heights
Corner Lot ____ Inside Lot - - X Setback Sideyard
Sewer Elevation _ _ _ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Garagg add3itiQn__.... Front — Depth Height Sq. Ft. Cu. Ft.
Front _ _ Depth Height Sq. Ft. Cu. Ft.
Type of Constructionwocd & stucco Est. Cost _ $1,500.00 To be Completed 9-15-73
Use frost footings
Firewall between structures.
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
.75 Beate 8"reharge
In consideration of the payment of a fee of $_9_,0_0_ , permit is hereby granted to Burton C. Ellis
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all Work
done in, around and upon said building, or any part thereof, shall conform in all respects -to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
thea city limits and this permit may be revoked at any time, pon violation of any of the provisions of amid
ordinance
Building lmqmtw
DARREL CLARK
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, Bas heating, sewer or water. Be sure to
the Building Inspector for separate permits for these items.
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA.
P
OWNER IS NAME s, �` U'a ef,e—BUILDER: �
ADDRESS: f/� �� c�,�l ADDRESS:
NO:. STREET
LOT; `Y BLOCK:—
CORNER LOT: INSIDE LOT:— �L SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
' Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height;
Square Feet; Cubic Feet:
-�--' O L
Type of Construction: (G"'��timated Cost:
To Be Completed: _
The undersigned hereby makes application for a permit for tine.workherein
specified, agreeing to do all work in sttict accordance with the City 9f
Fridley Ordinances and rulings of the Department of Buildings, and 'hereby
declares that all the facts and representations stated in this applicatCon
are true and correct.
*.1x: e / +// _ / SIG ATURE: / ig� ,,,� e e e!i e�eee
(See Reverse Side For Additional Information.)
�, &-d �iz�
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs 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:
MFOP4 BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic
fact, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.$5 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average,
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars. ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
'TOTE; 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 Certified Survey of the lot, showing the location of the foundatignp Qn96 it
has been constructed, will be required before proceeding with the framing,
CERTIFICATE OF OCCUPANCY
Application for a Certificate -of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
Ll
SUBJECT
E -RMI
City of Fridley
NF
-1i6672
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
EIPTN
COMMUNITY DEVELOPMENT DIV.
r � � PRpTECTIVE INSPECTION SEC.
� I �
CITY HALL FRIDLEY 55432
NUMBER
REV,
DATE
PAGE OF
APPROVED BY
s J�� 612-571-3450
910-F15
7/12/82
JOB ADDRESS 115 Talmadge Way N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2,3
1
Elwell's Riverview Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
George P. Lisanski's 115 Talmadge Way N.E. 571-3264
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 12'.x 14' Porch Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS AEWIRED FOR WMIMG,
HEAUNG. KUMBING AND SIGNS.
WWII diglin` cau fWaI utiiifiev
T RE •ELEC11 - GAS. etc:
UQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
ISTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,850
$.93
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$30.25
PLAN CHECK FEE
TOTALFEE
$31.18
IGNATURE OF CO TO ORAUTHORIZ AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
BLDG INSP E
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATIM FOR RESIDENTIAL BUILDING PEN41TS
(Nevi, Alterations, Additions, or Repairs)
^�
OW11ER:'j
G� t3UILDER:
ADDRESS: /S_ ADDRESS:
TEL NO: J' 7 / —7 y TEL NO:
Construction Location j,J�
STRICT NO: S_ STREET: �� /0-t ex_ cf/ .2 -C v a- ' (
LOT: , _ ? BLOCK: ADDITION:
Corner Lot: Inside Lot: Setback.: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
C 4/ Front: 12
Square. Feet: !(oo
Depth: ) Lf Height:
Cubic Feet:
Front: Depth: Height:
1
Square -Feet: Cubic Feet: _ r
NOV? 1(. ou
Type of Construction: Estimated Cost: $
ib $e Cbrapleted:
Proposed Driveway Width If New Opening Is Desired:
Alt. A Alt. B
SEE REVERSE SIDE OF SHEET
Mie undersigned hereby makes application for a permit for the work herein specified,
agreeing to do,all work in strict accordance with the City of Fridley Ordinances and
rulings of the Dej%irtment of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE:��� � d ex SIGNATURE:
StipUlat lionij
�f 30,aJ
71°_17 X93
?, i g
° e
BUILDING PERMIT FEE SCHEDULE
The Inspector of buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any
bxisting building or structure, or for any alteration or repairs
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 VALUATION FEES
$1.00 to $500.00 $10.00 Minimum Fee $15.00 plus surcharge
$501 to $2,000 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and
including $2,000
$2,001 to $25,000 $32.50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
including $25,000
$25,001 to $50,000 $170.50 for the first $25,000 plus $4.50 for
each additional $1,000 or fraction thereof, to
and including $50,000
$50,001 to $100,000 $283.00 for the first $50,000 plus $3.00 for
each additional $1,000 or fraction thereof, to
and including $100,000
$100,001 and up $443.00 for the first $100,000 plus $2.50 for
each additional $1,000 or fraction thereof
PLAN CHECK: 25 percent of building permit fee
DRIVEWAY DEPRESSION ESCROW: Concrete Curb Streets Only
Alternate "A": Removeal and replacement of curb and gutter only
Driveway width plus 6 feet x $13.50
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 x $15.75
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 been constructed will be required before proceeding with the framing.
/r-) -00
SUBJECT
_
City of Fridley
30545
AT THE TOP OF THE TWINS
BUILDING
PERMIT
i •
O.
rr
COMMUNITY DEVELOPMENT DIV.n
INSPECTION SEC.
/ q�
r PROTECTIVE
e
NUMBER
REV
DATE
PAGE OF
AVPROVEO BY
= CITY HALL FRIDLEY 55432
612-571-3450
910-F15
11/24/99
JOB ADDRESS
115 Talmad a Wav NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
1
lElwell's Riverside i
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jean Hainey
571-3540
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Tabor & Sons Inc. 1054 e7R9_1909
20014248
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION !fix REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 22 SO Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. OWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$1923
$ 96
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$69.25
Fire SC $1.92
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
-®'�-�'
PLAN CHECK FEE TOT FEE
Lic S $5
$ 13
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT MATE,
HEN R
Y V LID E IS is YO PERMIT/
B G ,NSP
QAIr E
SIGNATURE OF OWNER,,f OWNER BUILDER, iDATE,
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY 4-1
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �,.X
BUILDING PERMIT APPLICATION 30
Construction Address:
Legal Description:
Owner Name & Address: _
Contractor:
Address: /671 i
Attacl
lot, w
i
Tel. #
E A, MN LICENSE #
r e AA Tel. #
i to this application, a Certificate of Survey of the
ith the proposed construction drawn on it to scale.
DESCRIPTION OF EMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground _
OTHER:
Construction Type: (�0Estimated Cost: $�
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Ft x $
_f$
Sq. Ft.
Sq. Ft.
Sq. Ft.
DATE: %p�® APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
I
Park Fee $
Sewer Main Charge
`TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.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 [ ]
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits 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
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets 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.
Building
f
BUILDING
Permit No.: `
Inspections
$
RESIDENTIAL APPLICATION
Received Bye
763-572-3604
$
CITY OF FRIDLEY
n dJ U L 1 8 200
763-502-4977 FAX
$
7 'co
.001 times the total job valuation
Surcharge
EFFECTIVE 1-1-08
�-6z'i.
DATE 7_18-00" YOUR E-MAIL ADDRESS k hk 6 C o ci
t 1 c o— S a Cco i -t
SITE ADDRESS 11S_
—JJJL t"'I A DA -Cl. L✓ 4-1
$5.00 (State Licensed Residential Contractors)
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME: =C Atm
$
ADDRESS:1 1 5- —4 L Iw-,w 04-rL LA- A-7 CrrY t"& L_ `Z
STATE11' =4 -ZIP
TENANT
$
PHONE: 4:3 - .4 -( ( - S1 ® 5
$450 Conservation Plan Review
Park Fee
NAME: li 14 C Mo., L
1,�, ®,
ADDRESS: 1 1 1 O 0 L) 6�t v42� r1 1J CITY 1 �� o`t1�`� -,L. STATIf'"'/`�ZIP
CONTRACTOR
SUBMIT A COPY OF
PHONE6 �; �I 2 t - Qi ��� FAX
Agreement necessary ( ) Non Necessary ( )
YOUR STATE LICENSE
STATE LICENSE # '2__ ® Z(S 2_ 0 EXP DATE
2 - o lz�
PROPERTY TYPE
ASINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES ')..
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED JW WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
OVAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: P.rLPd_gc.ft L.I I;R, 51'2-C J- tv e:a ti
f r v G c c� i Pic o�
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT
REMODELING SUBMIT:
NUMBER OF SQUARES
E3 HOUSE & GARAGE
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1. Site
Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed projec
2. Two sets of construction plans
wnvnows
3. Energy Calculations
IN EXISTING OPENINGS Yes ON. LOCATLO OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF 1 = + i wo
OPENING CHANGES &
r%(1&v8ry
TYPE OF WINDOW TO BE INSTALLED L i t,, NUMBER OF WINDOWS
ASL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
tv (USING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $
f
®®ca --"
OCCUPANCY TYPE
Permit Fee
$
,
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
7 'co
.001 times the total job valuation
Surcharge
$
�-6z'i.
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
5". oo
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21= $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks Davable to: Citv of Fridlev Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and cases
of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the work will be in actor a ith r ed plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT L PRINTNAME (LI -10z', 14 ss?lt ^- DATE �0�V--
APPROVED BY DATE H
11 PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING ELECTRICAL AND MECHANICAL WORK