HomeMy WebLinkAboutSFRA2010-5888i "i 4\ A � s
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JOB ADDRESS:
LOT:
0110
DEG 082010
DATE OF ISSUAN'�CE:
BUILDING PERMIT APPLICATION
PLEASE PRINT
1 j q p L. , SUITE #
BLOCK:
BUILDING CONTRACTOR (company name):
CURRENT MAILING ADDRESS:
SUBDIVISION:
5950 Airport Frwy STE 300
CITY /STATE /ZIP: Fort Worth TX 76117 . P11:4.817-546-2000 Fax #t 817 -546 -2022
PROPERTY OWNER: h® � S e. k I-
CURRENT MAILING ADDRESS: 2.!e1 S ,--) Ly_
CITY /STATE /ZIP: Gm _ 0 ne X 7 6 0,S/ PHONE NUMBER:
G
PROJECT VALUE: $ % 60 JFIRE SPRINKLERED? ITS NO
DESCRIPTION OF WORK TO BE DONE: �? �ICaC p 3 i,v + L� C t G(�y r F' ��Q C�1 C% C: S
USE OF BUILDING OR STRUCTURE: j A
NAME OF BUSINESS:
* *Total Square Footage under roof:
Square Footage of alteration/addition:
❑ I hereby certify that plans have been reviewed and the building will be inspected by a certified energy code inspector in accordance with
State Law. Plan review and inspection documentation shall be made available to the Building Department (required for new buildings,
alterations and additions)
❑ I hereby certify that plans have been submitted to the Texas Department of Licensing and Regulation for Accessibility Review.
Control Number: (Not required for I & 2 family dwellings)
❑ I hereby certify that an asbestos survey has been conducted for this structure in accordance with the regulatory requirements of the Texas
Department of Health.
(REQUIRED FOR DEMOLITIONS, ADDITIONS AND OR ALTERATION TO COMMERCIAL AND PUBLIC BUILDINGS)
I hereby certify that the foregoing is correct to the best of my knowledge and all work will be performed according to the documents approved by
the Building Department and in compliance with the City Of Grapevine Ordinance regulating construction. It is understood that the issuance of
this permit does not grant or authorize any violation of any code or ordinance of the City Of Grapevine. I FURTHERMORE UNDERSTAND
THAT PLAN'S AND SPECIFICATIONS ARE NOT REVIEWED FOR HANDICAPPED ACCESSIBILITY BY THE CITY, AND THAT THE
DESIGN PROFESSIONAL /ONVNER IS RESPONSIBLE FOR OBTAINING SUCH APPROVAL FROM THE APPROPRIATE STATE AND
OR FEDERAL AGENCY (S).
PRINT NAME: V i L1 kev
SIGNATURE
PH #: 7-14 — 1 0'i i FAX #: 217-596-2021 -EMAIL:
❑ CHECK BOX IF PREFERRED TO BE CONTACTED BY E -MAIL,
THE FOLLOWING IS TO BE COMPLETED BY THE BUILDING
INSPECTION DEPARTMENT
Construction Type: V14
Permit Valuation: $
Setbacks
Approval to Issue
Occupancy Grou :
Front:
Electrical
Division:
Building Width:
Left:
Plumbing
Zoning:
Building Depth:
Right:
Mechanical
Rear:
Plan Review Approval:
Date:
Water Availability Rate:
Site Plan Approval:
Date:
Sewer Availability Rate:
Fire Department:
Date:
Building Permit Fee:
Public Works Department:
Date:
Plan Review Fee:
Health Department:
Date:
Lot Drainage Fee:
Approved for Permit:
Date: Ia. 71 It)
Total Fees:
Lot Drainage Submitted:
Approved:
Total Amount Due:
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C,ustoml -, -- Information'
Sireei Address: Z ��
C lid , Si &le, LI �' rc:� = 1
Home Phone. y " -� y -
\'Vork /Cell Phon
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Draw floor plan belov✓: indicate locaiien of proposed door /vvindow to be replaced, label room uses
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Size & Type
Letter designation
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