HomeMy WebLinkAbout123 N Loomis Ave - Applications/Reroof - 08/15/2013City 0�f+ Plannin& � & Trsesporbtion
FOr# �► olfins �t Coll 00 80524 P.O. �o a 0
OVEWTHL-COUNIMR PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). la Air Conditioning
D Demolidon (interior non-structural) 0 Electrical Alteration (not service change) E3 Gas Lighter Cl Comas .Log
13 Heating Unit O Lawn Sprinkler ❑ Mobile Hoare replacement C Uagofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation 0 Water Heater 0 Water Line ❑ Wood/Pallet Stove (must lie EPA certified, provide make, model and
manufacturar).
Complete all applicable Information on the application. Incomplete a�pp.,lle/atiorta will not be accepted.
tio Applican # � �i�"l 3, , Date Is /aC7 ( j
Por orAie use? arriy
Is this a resklential or project.?M'f esUential 17 Cammernal
If residential, is it Ingle Family Detached 13 Condo/tumhome (single family attached) ❑ Duplec
CI Muhhrn ly (apartment) ❑ Garage
If commercial, Is It: L] Bank 0 Bar ❑ Church E3 Hotel/Motel ❑ Medical office 0 office ❑ Retail
0 Restaurant ❑ Other (explain)
Is this building 50 yeer>s of age or more? U Yes 0 No If yes, ytw may neW to contact H sto6c P e-qan,.t n
If this is for a demolition permit, what year was the building constructed?
IfPnw to 19/-, ytw wilt need an asbestos ascueresat to submit wlth this ap ingfivn.
work f p-
*If lawn sprinlder/baddlow preventer, must list uoensed plumber. If first-time qlC, must list lice r sad dedrldan.
subcontractors List the a7mpany name ar oty ofJT caou AMINO a
SeMQW Plumber. Medtanical (tooter
I hereby acivwwledge that I have read this appilcation and stage ttmt the above tn;rrnation is camplae and Comm I agree to
damply with al! requGm"ft contalned herein and dy ordkarmm and state taws ►eaguWngl buddkq wrismicti a. I: know that a
permit is not valid until It has been paid arrd issued.
Print Name, Signature
I00/I00 'd 'ON Xdd Wit 55:LO NOVIOZ/6I/KV