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HomeMy WebLinkAbout11342 (5) - • � �xPrRE� �---�-- CITY OF DIAMOI+II?BAIt . COMMUNITY DEYELOPMENT DEPAR r q � � 21660ECop►eyDnveSuiteT90 : _.__.______.___.------ O.y�_Q� `�._.___�RE.�.___ --_ ______— ___-- ------------{909}8643t95Fax{9097861=3Ytfi--__�_.__� __,��, �"'""' BUILDING PERMIT APPLICATION • FIRM�.Y yN. JOBSITE �/�Q C.�`T i��//1 'T.�• APPUCATiON PERMR � P/C - o ADDRESS �O 1'[ i (J acC//�� DATE ` NUMB�R � ISSUE ` TYPE OCC ` , APN - _�LOT _ -TRACT _ DATE _ _ CQNST. _ __ GROUP � .� OWNER � � . _ �� _ _ p ADDRESS �C..-��P/O �i�. �ry ZONING SETBACKS Z �' r Q� fjJO FRONT RW-' ❑ CfTY� B�iP ZIP gl7GSTEL. _,.,_, REAR � � APPUCANT " T�L—�-.-�--.-. SIDFJSIDE STREET RW O � .. _ _ SIDE- _ _ . . __ _ . ❑ CONTRACTOR ' RDORESS c _-- - . . . - O _ __ � ¢ .CtTY�Ptt/�.}�i�_ Z1P PR�POSED USE . T�/ _ o ARCWENGi�— Z.�7 .., • , NDESIGNER __ _ _, _ _ ADDRESS NO.DWEL _ . NO. NO. : CITY ZIP TEL ' . UNITS . 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'__ _ .._. _ - - . � ... .__._ . _ -.. � UCENSED CONTRACTORS DECLARATION " ` W o� ��aeav�ccuwuw�nnEwunoF�aiumnur�w�icEnsEaiaroEarwrnnsionsoFcwwrEn. d p '�A� � i- p, -Y(WUMENCRiOY11TFiSECT10N7000)OfDMS10NeOF1}fE�)SINESSAtAPlfOFE���DE.AND z - ... �. . .. � w��xse�wciuw�wn�Ecr - 11�0 CdL �t/472 � �o ��risE w�ss � uc.r+o. ��D 0/ ,. ? - _ r . , ._ .._ J : V�u onsE corrr�u�cToa a � cd : ;.. _; . ;_ . - - wor�c�s'coM�SArrori oEaapntarr i p:3�� d N V �N6aesr�ccuwu►nEano+wnacvEtwmror+eocn�w�wwrmoEcx�TqNs: Z - , �»._� _.T_IHAYEAlIDWRLMAIHTARIACERTIFtGTEOFCONSENTTO3ELFNISUiiEFOHNONKFAS'�......_-. . _ .._.._..._..___ ._ _,....-. ..__._ _. . . WYPENSAiIOM.ASP�Y�EUBYSECTION97aoOFiMEtABORCODEFOR7}�PENPDRLUNCE W -....� ._. ., ��F iHE WONC.f-0fl WHiql T/IIS PEfiMli 5155UFA. � - . . - __._�__.................. . _.. _ .. - W _IWWEAfAMflLLMMtlIUNYIUFiKEHS'COMPENSATIONINSUN�NCRA9XC-0lXfi�BYBEGT10N - � . O ... i7000F'IFIEL7IBORCODE.FOflTHEPEflFORMANCEOFh1EMODPo(WHWHK%17tf8PEAMITIB . .. ..._._ .._._. . ._, . , : �ISSU�.M'�WORICE 'CqAEN5ATqNWSURAN HIERMDPOIICYtYi1BEHAHE:._ . . .CONSTAUCTI�d ... . , � a�qqEa��' PLANHEV►EW . . .. .. _ Z POltcv MnaeEH _. . _ �j ELECTRIC __ .. _.._ , .. . ---.__� . ,. - . ... . _. . . .L -o �����������,,.���� � ,�� � . Z I CERT�'Y THAT W THE PEHWRMANGE OFTHE WORK FOR WHH�I7HIS PEFlMfT IS I55UED.1 MECHANICAL ;..__(!} . .. SHALLFIOTEYMOYANY.PERSONBJANYLAlYJERSOAS708ECadE51�.lECl70iHE .. . . - � wowcEns caePeu�riorr uws�ca�owu�.u+o�E nus��sraun eEcoME � - - � MSPECTION FEE ... _..� . "". . .....- . .. . . . :. � SI�JECTTOTF�VVOWCER500►MENSATIONPfiD�A510N50FSECf1 70D�THEI/1BOH . .. .. � coo cW!v�vMn erhohsaws. -� ISSUANCE � + � . a � --, _--._ ...__ __ __� — �__ _.. ._. .. . � � DATE: . . APPLGANT /L'VI`�i�/J ��` SMIP . . �. . .�- . wuwirxi:r�t.unfi tc sEcwwaE wowc6nscaavENs�rnx covEw�cE�s u�wcia.ua sw�t eE ENERaY p!C c �y, SU6IECTMIEMPLOYERTOCRNAMN.PENALTESM�CMLFNIESUPTOONEHUNDRFATFqU3AND ��R�YPERAM7 � �„ OOLUR8lt100�9aa�Mil�qT10N TQ THE COSTOF CddPENSATqN.OAMMES AS P{qVIDEO FOR W- . SEC1DN97WOF7FfELABOfiCOUEWTEREST.ANDATfQRNEYSFEES .-_.... .. _._-..... ...... ... .. .. FiETE1JTI�N FEE: _ _ , Q, CONSTRUCTION LENDINCi AGENCY PRE-AlT FEE ' O __ _ _ _ _ _ _.. _ . _ .. � I HEREBY AFFlRM UNDER PEWILTY OF PERJURY THAT 1HFHE i6 ACONS7RUCTIIXi LENONO AGENCY ..... _ - FOR 7HE VEHRDNMIINCE OF iME WOFIX WH WNiqf TMIS PEflNiT 18 I&SUFD(SEG 90YT.CIV.C.j. -_ . .� . . _ . ..... . . .. __._...... . . ... ......... .. . _.. .. .. .. .. . . � LENDEAS NIIAIE , - . ..._. _ _ .. . .. . .___..__ _. ,_ ... , ' - F,_ LENDEHSADUlIESS.. . . . . °_._� I CERTIF/iHAT I HAVE READ iH�S APPLICATION MA STATE THAT lY�ABOVE WFORMATION I5 COqRECT. TOTAL FEES __.. ... � � IAfifiEETOCOMPlVW1TilALLCITYANOCAUrTVOimINANCEBANDSTATEUWSHEUTRlfiTOBUft.CINO - ` CONSTN1CTIdlANDilEHEBYM/1ilOWZEREPRESENTIUlYE50FTt16COUHI�TOEMERUPONiT1E ��' � . . � �aove•rmr�m vraPEatv wn uur+Ecrarr auarosea COMMEPI7S _ _. .__ _. . � � . . - —.,., -- _ _ ,..__. . .m .,PE EEW1MEiPPoPIfI�.�.� . .� . .. � � y . .. . ' � - - C/) .__..� OFPEHWTfEE . . . .. .DA E. .... .-..-._ .. .. . , ._..._ . .. � � g RECPT.NO. PAID BY VlWDA ; F WFNTE—�Dertmenl CopY,YELLOW—Fine�ior Capy,PINK--A�u:wr Copy,GOWENROQ—F'�e Copy,t,HEEN—Applioant's Cnpy . . � _ _ _. _ -- „ ; _ _ . _, � , ._._ .. : _ ,,. "�._ ,. .. . ' .I.��" , ' '� .... . . ::�,�. .C.0 I... :\ .:���',.'. ".. _, �� .i��C. _. �I ., . ,. 'iL:".. � .�'T ' ' ' " '_ �T i � , i ` `' - �c� i I � _ jI I- � � I � �� '� ' i � r i I � � I �, -I, �'. � 'i � �i I � '. � � i� �1 ��� � ' ; i �E�� •' � i' i � � � �� I� � � � � t� � . �r � � " ,,� � � ��� ��� . t' . . j i' �1. 4 :i .� - i� I � /`, �` � � � ` i � I � � '.f I ; � . 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