HomeMy WebLinkAbout2618 Brownstone Ct - Applications/Reroof - 09/16/2014This application is to be used to apply for the following permite only (Check all that apply). 13 Air Conditioning
Q Demolition (Interior non-atnictiiral) p Electrical Altefagdo ...(not service change) O Gea Lighter. n G'as t ag
❑ ttegng Unit O Lawn Sprinkler ❑ Mobile Homa replacement )f Roo rRng p Sewer. sine 13 Photo= halo
C. Ventilation 13 Wafer heater ❑ 1 tkler Line Q WaadyPal_►et Stave, (mustbe EPA certified, pra"vide �nalae; model and.
manufacture*
CAmpleteaii applicable information on,theapplicaUon. incomplete appucations will ,iioi be aecepted_
Application.# Date.
Forofiiau use only.
Jolt Site Address (hgeured)
Value. of,ConstrucHon (labor, matariats, profit),
000
L6
Property Owtw NameAddress
City/State Zip, Phone'
r
1 dVC
Applicant Name Address
CPtylswe Zip Phone Q7a -
#+�-�o��abic
Centmctor Address
r /State Zip 'Phone
(bntraemr, Qty. or K. Collins Sales Tax s
Are you pay'mg ta=. .harece by report? R( ere ❑ Report
sal�2zrau rbertsreourrerar0yea awtaarems
Are yoirpaying m th.your trust aconi is3'Ye; ❑ PIr;
"ssthisa ra derfdal osmmmercial pmleW WResidadial Q Commeraat.
if residential, is iC (single Randy Detadled. 13 Condcytawnhome{single famlly.attached) C Dudex.
Cl Multifamily (apartment) . ❑ Garage
If mmmeri zi, is is 0 Bank ❑ Bar. ❑ Chun ❑ HoteUMotei ❑ Medical of&n ❑ Ofrice E1 Retall
13 Restaurant 13 Otim (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No. 3fyes, yvy maynaed io confact his�rri: Avsa= wbbn
if this is fior a d6walit1w.. perfnit, whetyear was thli-building constnicia -
rfprforWI97;'you.w9lneW;vhasfr am rentW5&t nftMd&drrisappicablon
ESN
*If lawn eprtnklerybaddtow prever b , must listCk nwA plumber. If M*tme A)C,'must list lio.msed eleriiidan..
Subcontractors: itsCilreaarrRarry►ramzarQfpoPftCblJ�hsPeensa+�
gecte. Plumber Mcdrae6 Rooter R-' 1$S9 -.'other.
I hereby aclmoW.edge the tI have read this appilmilon and smote that ilia above inrommuen is ebmplete aid correct 2 agree to
comply with all requirements contained Herein and dty mldinances ild state laws reguWn® building Con%MuU on•. I kcnnwthat a
permltls notvalld until It has been paid and issued.
Applicant: j.,ti
PrIntName- M� < Chw.tnq S S3armurle Dace -