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DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT FIRMLY
JOBSITE
ADDRESS Yy I -I P I E O
APPUCATION PERMIT USE
DATE NUMBER y 7 CODE
ISSUE .
r _ yt7 TYPE OCC.
DATE CONST. GROUPAPNLOTTTRACT
CROSS STREET
OWNER
ADDRESS
SETBACKS `NW40W E.4r.
ZONING FRONT RW
REAR
CITY ZIP TEL SIDE/SIDE STREET RW
APPLICANT TEL SIDE
CONTRACTOR ECI71401fC r-
ADDRESS.; l P49 '
CITY (eZIP 7 v y TEL.
SEWAGE PUBUC PMT ;>k
DISPOSAL PRIVATE SO. FL/ 100 GAL
GRADING CU. YDS. EXC. CU YDS FILL
STATE
e' LIC- NU:,raBGRy
Cl) TYPE SO FT FACTOR PS ADJ. AREANALUATION
ARCH/ENG/
DESIGNER
ADDRESS
W 1
U- 2
C5 3CITYZIPTEL.
PROPOSED USE
Z 4
GARAGE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
PORCH
ca VALUATION ADJ. AREA
QUANTITY DESCRIPTION FEENO. OF BLDGS HOW
ON LOT USED 4
l LY:ED CUNT P.ACTCI!S DECLARATC`i 1 Wety at him that I am Acetsed uMe, prnriOmt at Chapin 9 lconmiencing
xnh Sa:,:n 7330; of 6.nwt 3 of the Bas:ress and Profmiors Code and en license n n lull hme a'd all's•
U
UW
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CANER &PLCf R DEC! AR -TCN 1 teiety nfnin Mat 1 am aseno Flom the Conuactr a Lernse Law Ir dr lailawn•g
iii—i ISec 70315 P.us—& red Pielnsina Code Any City Or ewn!y which rrymin a F.—I So consort.
i:e• v, -p -e demel:s`. Ar reran aM Aurora pint to its vs—ce as0 reures the spckul for such eimn
to I..e a Land va-,+ t Ita! he a kwPd pasuant N Its pwarers Of the Cmnattd'a two,,,Law'hapn
9lcornmw<'rg ..:h Sett.m 7C =i of D:vn- 3 of Of B,ismeu aid P:ofeslms Coln r Mat he it I—TI therhors
art In, a Pn ubircnaMthetatsleiOeale7rdnrmpncnAryyiUanCnofStchot7:,31 5 by ary aaracrrm
On armum to a cidrosp!, Cl not me Cm I- Purdxd 61- ISSr.•3f 1
Eli. as owner of dr popery or rt, em -•eyes wit wrrs as V- sale wmre^u'nri w..IId0 Me wmk and
IN tnuctaie n mt mfr,dad or M'Pied he We (See IZ44 Rosiness and Pro!eumrs Code The Cos for'3 Loss—
Uw Ms nc! acr'y to an owrer of li—erty arm builds or ",Net Thew and who does sob ""l""""(
d n.:is"h Pis
rmown
enCi Met Firm!"shot sucl <r"__.Ts ane ort: rtrndnd n ollned f0• safe 11. hew_.
Me bi:il[.rg m pwrmrrt a sold wiM.n erre year of to+rle!m. the ower Wilder will hese Cie Elden of Foray
i oat to da mor tine or ng•me Int rte fruiprse of are 1
r 1 as ewnrr of re pepe'!y n evks:.e4 Wetrwiry w0- Arensed Ooream't to ems:ul the part (Ser
7614. Bas.ness and Pmirssms Code The Comiaeor's Licrte law dues oat oras to an ower of posyrrly wr.
s-1bu.hls o• im;.wes Mnen, sand b. cont-vi,Ir fah p•cfrcn A.A.a emtrr!erls) Ycr-sed pmsua^t b It
L<erse taw l
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CONSTRUCTION
I sit rano• ern Sec . 8 Is PC lAtUch Corti':catel PLAN REVIEW
D.ir o»Y'
J
ELECTRIC
PLUMBING
MECHANICAL
I MR%ERS COME SATION D(ARA"10N I W,'y . Over Mat 1 haw a uiMica'e of WWI to tell mut. a
uaerrbi m el YOnns Crnpersaw Irsi»nce. as a crr!ied tory Mored 15rr 3&D. Lab C)
C",.,.,d racy is hereby t—shed
i Corded dory A lard w•M re Briding lnperr.m Defartment m D"siriert AGRADINGA F FN
CEP.•:FCAF[ or E%EIktPIC4 FROM W,11'.%[AS' CDMI1NSAT:3N tNS:?C:4CE This rction Ord net be terpletnd
d the Print is For ex huMfed ISIL:; w less 1 lastly Mat in d4 pplormanca of the wml loss u<h Ins
Pr—I is rss.Od 10.11 not smoky any Pawn n any manner So a become wb t to the stet Caryenu!.on
laws d Ca'd.rniaLu
p Cate A;rl ort Uj
LL
ISSUANCE
SMTP
PARK FEE A n rt 1 R(1
SCHOOL FEESNOTICE16APPLICANTA, after making m: Cart I<a:e 011 O!mrl a . yma S%OA aibint as d< lhkrka'a
Cmprrsanm pmimors of dor Libor Code, we mint 1.9-n tvnpsy it. safk _ ton' re INS permn Shop
k dared imbk j
L'IT 1- I IV:v w
EAL'.S3h Dr 14'X.STPIAL SAFETY PERMIT CERFPCATICN
a [31 hrete E111.11 that no nu,nan IM 151 or me Net in drsTi nn which a person o rma,md to dewed. BIUIL t 1 +
wd bop els=e m emnrctrn wM kwil wifimeH bt, Rus perms and Mat is. bwKiy santarr scsfIowwg tahewo k.
or drmolim SO d.smar7.n sheers, wd be me Man West, oa 1361 fest ho Ihrn 37, G7 2. An 2. Site
341 - 1.de B. CA C)
C OAS awns b.AU,. 1 .Al MI Ieeley trWre to ai work area w ld sella a Partin keen M Covolm N
IMnins! Sa'ety. as noted ebm Press tat prrnw has a permit 10 do soh work Front Me Warms
E
N.— of kd:rtes.l Safety Firms NO TOTAL FEES
C.7ar, Zu%Ik urdry 6 f :1407' 1 ketely a4,m tat thea is a t .Frost am land" "—y la Mr pnMnwn
e_ M R< wo•k In %hick M.s pnmP n Owed (Sec 31197. far C)
lender's Name COMMENTS
oLaMers Admen
CERTIFICATE OF COWLIANCE AND AJTNMZ-KN OF ENTRY I satisfy I haw read piss appkrm and new
n nn lb nfymal.m own n Correct 1'Wee to ewi plr wnh N SUN Nws and city ranrte rewwy m hdkaV
tmshatim, .it IF, a Irpnpn1.4- d ns. Dgartmen d 11'eld:'S and Safety to rib Oen Mr poetryappindIrItpannfmofNrwhich1 -a dairy mtprront
X J
lop `ge Y 3 PAID BY VAUDATION7RECPTNO7
S;, 'r Apphcrsor :t Das.
WHITE—Departrtke!ht Copy, YELLOW—Finance Copy. PINK—Assessor copy, L,ULUtNnUU—hila c=opy, UMM14— APPtrcartis l opy
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