HomeMy WebLinkAbout21 ROCKWELL CTBLDP/(rSm
Electric #APPLICATION FOR BUILDING PERMIT
The undersigned hereby applies to do work according to the following:
Applicant wOVlci’l (11015»LocationotWork 62!‘RCr/r‘’v/f/z cf LotNo.
Applicants Addr)ess 5’5 ‘i QR”DRFW‘:J7—Tel #8&6?qéz/c)?:Q
Town ?J«7’I’kw\.>w Zip Oélif‘a Lic.#06'56 WOQ
Owner TUhI’IV 671.2%Architect
Owner‘s Address 92}(ROCkSeW (7'Architect’s Address
§b0 Zip Zip
Sq Ft NewArea 1stFl W 2nd Fl 3rd Fl Total New Area
Purpose ofthls permit Q€MUU€@)<1¢/M WEwq arr/m,“A)”WW é /Qp/wuk
z M I.%w/"L {/%(Ae/S ”Jigt/a’m /§T9ci/I
City Water 3 Well 3 Septic System 3 seWeI’j 92§’@Oigq#_Ins:HO S \*t.Area Basement Garage
Approved by Date .=Use Group Construction Type
Revised 1108
Plumbing #HVAC#9i KoaLwaH Cam Date:
Sprinkler#tgawqg Estimated Cost $1’90‘?FINAL APPROVALS Perm'1t F66 $’I s"BuildingEngineeringAffidavitAppr.f0rCO.
COMPLETE RED BOXED AREAS
TYPE OR PRINT ONLY
>SIGN ON REVERSE SIDE 4
OCC upancy FeeEng.Insp.Fee
Total Fee
(Additional C080
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