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1'.s.� � � Y i J i r✓.s„'yvnt.el' �'r'.-kai� Pxvrv,��Y�5D9�{K�f'k� ^�n.S�� �/Ist"'Sfz r � �'�/}��r ✓j¢;�>'u�„'h�z`�" >'�W,i�i'k�k rr'^I"
P 1 tti a ✓eyx 11 I n s r at( }'sy lea - lr@
.11>
PPUC/ I ION,; FqR RESJDENTIAL FBUIIDING PERMIT f r PERMIT NVMBER a2Q 2 ".
•R APPLICANT. • FILL IN
tt
CERTIFICATE OF OCCUPANCY
'6UtLDING IJlSPECTItlN DIVISION v y STREgT'ADDRSS OF a JECI
' • • Legal Description reel Block o
c �' Descrlpllon of l4brk ��J,ANCJ Sa dy GJpe' Hm 1r.
Plans:RecelYed BY Date ' -
REC MISna Sti rvey Calca'SING Energy, Elacte h1st Slrugl Improvement on ParceC;Yes No Area of Bldg-'
Plane Ateoked By Date Saparale SirUclure or Addhlon/Alteration to Ezlst Bltlg
Applicetlon Approved By pate No M $tortes r Uso of Duild{ng s",r
Valldeted ey ' Date Valuallon -
CompendaHon Cerllflcate er)fletl By ..i Date Owner
- '` $ 3 - CONraclor Gh us Llc w
'b Contractor s Atltlres9 'hone r -
Parmit Fea (plus penalty II sprilic��j g �� Conlradlor Eleclnpal Ph
Plan;Chock Fee(loss doposh of S 'Rct��p )S S 43 City Business Licenser ono
Energy. Plan Cheek Foe (Dep o $y Rql # 1T u� ,. -
'IrM,rHU. 1- . Clt BUslness Llcenso e - Phone
Strong Motion Foe Fi /1 t)n . a A W Hoatlny and Cooling
Plumbing Pormll'Foe .: I $ ��r� CII BuslnOss Llr•ense k Phone
rf;Eledtrlcal Permll.Fee ArchNect/Designer ., Phone
Medi Htg /CooIB Pormll S u C' $ "
Reejtlenllel' nstrucllon Tax `: �.� ',; Engineer Phone -
Mlsc: Fe
_-,. ,g, .,. ;Len or: .;, [� Unknown
MI9C: Fee $ cmllly Thal;In Ino porlormomco of Oho work ier whmh Ihb"Isermft le
'Issued poll not employ n,t person In nn m rine;sp as In bocbmo sublecl
e J to Iha workman s'c ansallo 16w C �I rola'
- SIGNATURE OF G/ /J�/o/�/'� Y (//
• • APPLICANT/OWNEIs�, lC %/ OAT
F,Ovlronmpntal Status Exempt OtN6r .. °'1 co I fy dem_@s Ino Ikm 1 not nconc•tl unJ In¢ v o)?Ion+ al me
Design Revlew'Approval Bldg SI\a Slgn ''"omramms uconw ond.ledhor Ihel my:[Iwnk Na
UseiZone .P D Condit{Ons Oh as ileal on. is"In full force and o6o6I or
gond Usa Porrnl! a Variance r ParIII S aces -i mrliry Ilu1 dm exempt Irom.lhe L(cendod,nenuira J Drovlelone of Ih•
'ApprOVed By ' Date �'Corl act6in License Law. (Slate bital+:of onumpnot
:I-pnreby eekiowl.unIa laal I hovo irend'Inis 0'Icalion'Ond elate IBnl.lha above la
forA age ¢ 10 ca ply w h all:Cit Y Ordma c a an Slalu LeWe reBuletinq
.. uuralnq: a '.
1 (Were it t0 se"ll Ino@mol /intl:;koap harmlges Ula Clly UI'C,Uperllpo
ncrOOChme 11 Parmd Gfanl 91 Easement
Witlittle e;Iutlgmenls costs and ex permed which m0Y In any way
ur0 GUtter, SldeWmk DnVOWay RsoIOCe :'Repaif accure a0alnal neIJ�C IIy In consequoneo of lha granllnB 01 Ih la!pormit }
Conn Fee$...
Water.:. . Meter $ SIGNATURE OF
reement for.Completion ol'Publlc Worksilmprovemeals APPLICANT/CONT6ACTOR DATe Y ,}
lark Checked;By .... Data;. Approved By .;:7. Dale NOTF.:�:Whu properly. vehdated thir:.lorlq con+Ululea A aUlidlpq pnmll TM•
pnmlD:c pi end b¢cam + null pnq field Mauld work not ba
co in wlutn
• •. 5Ya'Jbye nom vnlltlgllon
'or:. oultl aulharizetl,cbA+Wcllaq be ju+p•nMd qr
Wantlonotl for a p•rlod:ol 1Y0 tlays after,work Is commoered
PERMIT`INSTALLATION INO EACH FEEAPRLICATI
PLUMBINGON
Light Outlets " . SWdchci
-Fixtures ....: Receptacles::i PERMIT,INSTALLATION N EACH
O FEE
TOTAL NUMBER (lass then 1000 walls) I g.60 �'; Gas System with-:up to 5 outlets . S4'e0
"Range :. .'Cooking Uml .:.. Oven !-.2 00 I Each additlonel outlet 1.00
Dryer Garb, Dlsp Dishwasher I. 2 00 . .: Water Syslem (Installation Alt. or Repair) .. 4 00
'.. MOTORS: 1 HP or less _,.... ....._ 2.00 �.a•P'L) Water CloseL... Welor Healer..: Ld.TraY 4.OU '
.Greater man 1.HP not more Ilion 5 HP .....I 3 50 ._. 'Lavatory... Shower Pan'.. Bathtub... Sink� 9:00
-Temporary Power Pole or Service: IOO,mop . L,6 00 I Wash MacM1 Dishwasher Garb Disp 9.00
—200 amp.1 .. 7.00 .: Sewer .... . .... ..........................' ' '......
.. ie.00
Time Clock ....._. .... .,. L...L, 1 50 I �..[,.v . 'Lawn 5prldklor Sya -$5.00 Ea..add eye. 52.00 ... .... ......:.'
Mice.(see Ord. current l.....'..... ..... ..:..........a..................:.. Vacuum Breakers ..............:. :...: . .. ....3:50 : ' .
New Residential.Occupancies Flat Ralo Interco,, :..... Water Softener ... ......... - .. ...9.00
Plumbiny Piping without fixtures .. 4.00 jYA'—
0-600 sq. It. $22.00 1501-1750 $34150.....................:. ... ....
....... Mleq• (See Ord. Currant) ......................:.........:...........:::.......
501-750' 24.50 1751--200(10 37.60;........:..................... -
751-1000 26.00 2001-22'7 30.50..........................:... Permit MBI ..................T F - .. ....... $6.00 '
TOYAL.PLUMBING PERMIT FEE (plus.penalty If app ''])
. .1001-1250 28.60 2261-2500 42.00.:............................
1261-1500 32.00 2501' 2760 49:50.............................. + •• ••
. 'Permit Fee................... . .... .$6.00
TOTAL ELECTRICAL PERMIT FEE,(Plus penally If app_pl 39s� - -„_ 'PERMIT INSTALLATION - NO. EACH FEE
5 e.0o i.
• + • : ver 100M .. -10.00
Forms /-Foundnllon ... 8Y. Ufile: Comfort Cooling UniL..:.to 5 ton HP .. .. . 6.60
Plumbing Ground Work ., L - toSriton/HP . '.1200
Rough Electrical .. Io601on/HP t7 op
tame Plumbing rind Healing _Space Heeler...:.. Well Healer 0 00
ae lUllo l A'EnarnY { .' t. Flues other Ihan a .0/0 .'3 00
as Test .. .. ,. Vent Fnn Kitchen Beth'. I` '3 00
Tampvrury Power.608 / cl s �? Commerclat:Range Hootl 1 0 00
'Final - Fklaefdopl I. . I Misc (Soo Oroipurronl
Incl - Bulltling/ echanlpel POrmll Foo-
Final Doelgn':Revinw / Lagescapmg - I TOTAL Htg r Co01g Pormll Foo (plus pennlly If app []) $
trial Publlc�:Works
'.
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