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Ntlt n C ectal e110n Insurance affidej wuP be complcmd and submwd-.•ids lhn appl r.+��on.1 uwi�w pu.r.1< <br /> result in the denid d the issuance o(the 1 ny permit. - <br /> SagneA ARd?vii�Atsulscd'. V.0 No ' <br /> SECTION 5-DESCRIPTION OF PROPOSED WORK(check all appl)cablr) <br /> O Almlotlion0) O Addiiian Q <br /> Nr.'Conzontction O Eaiuirg budding Q Repau(t) <br /> Aecosory bldg Demolaion ❑ Oshe, ❑ Speu(y" <br /> Brief Description of Propmcd Wak: <br /> _1tc�r�LaL •C+o+kZ GP�AGE -�rt�-� :'-�°�'c� <br /> 2 2 14' <br /> Stmnurt-Overall Dimension: Length Width — h g <br /> ht <br /> 5ECTION 6-ESTIMATED VALUE OF CONSTRUCTION <br /> Item <br /> Estirnmed Value to be Off tial Use Only <br /> complued by permit applmanl --_ <br /> !.bui!dtny (a)Building P<rmit Fee Mu0lpfmr <br /> (b)E.umared Tntal COU of <br /> 7. Etetift[al Cnn INCtion from(6) <br /> 3, Plumbing Building permrl Fcc <br /> 4 6j"IlaLlit11(HVAC) (a)+ Ibl <br /> Protecuan -- -- <br /> 6. 7nral=(1.7.3Na31 Check Number _. <br /> SECTION 72-OWNER AUTHORIZATION-TO BE COMPLETED is HEN <br /> OWNER'S AGENT OR CON TRACf OR APPLIES FOR DUILDINC PERM 11 <br /> 0.4er of the suhgo propctty <br /> L_ <br /> tout on <br /> htrcby aathonu — <br /> my bchaif,in all mattes«Imne to Z1.authuriied by ih.e bmlding permit application. <br /> s,......... <br /> 1- SECTION 7b-OWNERIAUTHORIZLDACENT DECLARATION <br /> .,1f. Lrn tslrL r:OWneriAuiho+iaed Agenl <br /> herby dedart Ibai the Sialemen" a1W 1A 0471041100 on'he(uugomg applicaion nrt 1M1e <br /> anJ arcunm.Io tht'.xyt of mY ARo.vIN;c and <br /> beim( <br /> Slgucj under the pama and penallats o(periury <br /> SECTION IH leUNICIrAL DEPARTMENT SIGNATURES OR CDECK OFP <br /> Co,�tr.auoa_ <br /> DPW(Road Cut) <br /> __ — <br /> Soo of)len"h. <br /> Saito Taacs <br /> Dnard of APP-111 -- <br /> Fire fkpt. _— <br />