|
<br />IE
<br />
<br />CITY OF LOUISVILLE- BUILDING SAFETY DIVISION
<br />RESIDENTIAL PERMIT APPLICATION
<br />AV
<br />L\'M~,J, t I ~~N\~
<br />BLOCK: SUBDIVISION:
<br />ADDITION: () AL TERA TION ( )
<br />
<br />PERI\1ITNUJ\1BER:
<br />
<br />1) 0 C1 -~ 0 00'1
<br />
<br />Ab15REs so FjOB'~ -, I L...
<br />
<br />LEGAL DESCRIT10N LOT:
<br />CLASS OF WORK: NEW ( )
<br />BUiLDING
<br />O\VNER:~,,~ \~~) ~1\oEiL.- ADDRESS:~-z.,~ lD~-:;;r
<br />CONTRACTOR LOUISVILLE LICENSE # ~l..Db"i1-,
<br />NAMb-4~(L'f-.,~ \1.~1"IVi5~DDRESS: ~"1..~ IO'T!l. ~7\
<br />JOB SUPERV1S0R~M b,~ MOBILE/PAGER# ~.~~ ~#('M!,l"
<br />ARCHITECT/ENGINEER OF RECORD: COLO. LICENSE #
<br />NAME: ADDRESS:
<br />DES C,:\:,I..EI' 0 N}? f\lif.9 ~K.:f,lL LIf\l,.,~l:l::,.A.e E l:LC;.A!3 LE BOXES
<br />I5I FLOOR AREA: 2nd FLOOR AREA:
<br />BASEMENT AREA:
<br />TO BE FINISHED: UNFINISHED: SPRINKLED AREA: A/C AREA:
<br />TOTAL LOT AREA (5Q.FT): ROOF COVERING: EXTERIOR WALL COVERING:
<br />CONSTRUCTION TYPE: OCCUPANCY: TYPE OF FOUNDATIONS: TOTAL UNITS:
<br />ELECTJUCALPEI{MIT INFORMATION:PERMLTTO INCl.;lJDE ELECTRICAL \YORK;:'(:),...8!i.~"1'i.OTA.I'pLJCABLE .(J
<br />CONSTRUCTION SERV1CE ENTRANCE SIGNS ELECTRICAL APPLIANCE FIRE DETECTION SYSTEM
<br />METER SIZE: SIZE: TYPE: TYPE TYPE:
<br />PLlll\1BlNGPERl\llT INEQR1\1ATlON: .,PERMIT TO INcqmE PLlJMIllNGWORK.(J.: .... NOTAPPLICABl.;.r;:, (
<br />BACKFLOW DEVICE ViA TER HEATER FIRE SPRINKLER SYSTEM WATER REPAIR
<br />MAKE/MODEL BTU INPUT AREA
<br />MECHA)liJCALJ'ERJ\lIT)NFgRMAnO,N: ]'ERl\llI.TOJ,NCLUDE1\lEc::HANICAL\VORK( ) >.;,;, NOTAl'PLlCABLE '.t)
<br />FUIZNACE TYPE OTHER GAS APPLIANCES GAS PIPE SCHEMATIC ATTACHED
<br />LENGTH
<br />
<br />REPAIR: ( ) MOVE: () DEMOLlTlON:])(J
<br />PHONE: "lll~~ l"5' -~t)
<br />CITY~~IP: !30~
<br />CITY: PHONE: '"3,o?,.-t!<2.."!. -"'lCP13t1
<br />~l;L ZIP: e3o....oL\
<br />JOBSlTE PHONE #:
<br />PHONE:
<br />CITY:
<br />
<br />ZIP:
<br />. PLEASi:: INCLUDESQ; FOOTAGE
<br />", ,"".':'>.." ' ,," ,',.. '.' ,.. , ,'i,'..' .. ,. ,'''', ,', ...<0' ..__....,_..'...'.," . ,..... .....,:'_... """_ ,~.,1" "~',.' ." ,X',- :;:.~,.,.'",..,.h..,",.<.,."..'..,
<br />GARAGE AREA: OTHER:
<br />
<br />SEWER REPAIR
<br />
<br />
<br />
<br />
<br />VALUATION S;
<br />
<br />
<br />
<br />INCLUDE L",BOrz ~ I'v1A TERIALS
<br />
<br />(8UILDING DEPARTMENT WILL CALCULATE)
<br />
<br />
<br />
<br />ORnn\IANC'[S GOVEE)~iN() THIS TYJiE Of WOp,,: WiLL BE COkWL]EJ) \\'ITH 'H)-tETHEP. SI'ECJFiED I ifRW\1 OR lWT THE (iRAI,TiH(i
<br />SUBJECT TO 8[(;I)mll~C
<br />SWJ!vlkllNG POOLS tn~l_ESS NOTED Oi~ THIS ARE !\SS~~~SED ,'IT TIME Of PER~iIT Aim ARI ORDilJAHCE
<br />
<br />
<br />PRINTED NA:\l
<br />
<br />
<br />
<br />SIC!':ATUHE OF APPLICANT/OWNER
<br />
<br />,,(HE: FOR.\ Ml'LTII'LE TR.\DE I'LR\.lIT TilE SliB~CONTR;\CT()!, SIGNATl'l,e FOI,ill WITII CWICIN\L SIG:\ATC:RES IS REQUIRe]) Pinon TO
<br />ISSU.\i\CE 0 F TI IE PEl,\. lIT
<br />
<br />CITY OF LOUIS\'ILLE
<br />
<br />7.j\) .VIAIN STIU:ET LOUIS\ILLE. CO SOl127
<br />
<br />(3113) .J3~..j~S.j
<br />
<br />IJIITi 3J~..j"SS Fax
<br />
|