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Project Information
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Building Information
New
Addition
Itemodel
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Uccupanl loa
Budding height
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Dial agnate Ioouge
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patting
Doer
trap patlung Spnokkr system Uilical Material
Contractor Information`
limiting and insulation information (R—valuta)
Heat source
Mat ceding
Below grade wall
Uoor (u—valuo)
0 1 window area
Vaulted ceding Above gladewall
Floor blab on grade
Window Pumice chancy
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ul i g contactor
License number Phone
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Mnbng address
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Lily, state, rip
Li y,dale, rip .
-healing contractor .
DIWOR oder
Lkeme number Phone
License number Phone
n ing address
Mailing address
Illy, dale, tip
Cdy, dale, zip
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I hereby certify information submitted is correct and there are no of
as shown
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Owner or Agent
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I hereby certify information submitted is correct and there are no of
as shown��
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Owner or Agent
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Sewage System
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Stories / Dimensions ni4 i , v :3 .._ Total Sq. Ft. 76
Rooms / Baths A/4, Basement Foundation Const. a,ibit-e,aLi. Chimney
(Full, part, nonefa—
Heat. System Types9i Roofing ,Ext.
,Ext. Finish 74{-e74-7- Int.
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PLOT PLAN
Draw sketch with dimensions showing: (1) property lines; (2) street or road locations;
proposed buildings; (4) distance to property lines and streets; (5) dimensions of buildings
tem and water supply lines.
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1 hereby certify information submitted is correct and there are no other structures lo
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as shown
Owner or Agent Date
A LAND USE OR STRUCTURE PERMIT MUST BE ON THE PREMISES BEFORE CONSTI
THIS IS NOT A PFRIWIT.
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