HomeMy WebLinkAboutCOMA2018-1511 I r` Vito DATE OF ISSUANCE:
EPERMIT#:
BUILDING PERMIT APPLICATION
(PLEASE,PRINT
, L�EG�IBLY-COMPLETE ENTIRE FORM)
JOB ADDRESS: 3� 4\=� �KA1�1(1►�r. Mk LLS �As . SUITE #
LOT: BLOCK: SUBDIVISION:
BUILDING CONTRACTOR(company name): aST ms4ra a mpnym
CURRENT MAILING ADDRESS: 4 % s6, tjo c-r -= Tz-
CITY/STATE/ZIP: ISS(1 �`� PH:# G Q�Q 34 Fax#
PROPERTY OWNER: G2p( i 4- Q 45'afOdr, L`f
CURRENT MAILING ADDRESS: I72y '80 V n4 S'r" -4-77o Zo `"
CITY/STATE/ZIP:`T-,L 5/ \ r';,9A 0 PHONE NUMBER:
PROJECT VALUE: $ FIRE SPRINKLERED? YES _ NO
WHAT TRADES WILL BE NEEDED? (Check ones that apply)ELECTRI PLUMBING MECHANICAL
—
DESCRIPTION DESCRIPTION OF WORK TO BE DONE:'Z]f3T.e0 o;r�[ as VW n to
USE OF BUILDING OR STRUCTURE: Gall, I IJ
NAME OF BUSINESS:
Total Square Footage under roof: Squar Footage of alteration/addition:
KI hereby certify that plans have been reviewed and the building will be ins eted by a certified energy code inspector in accordance with
State Law. Plan review and inspection documentation shall be made availab a to the Building Department(required for new buildings,
alterations and additions)
❑ I hereby certify that plans have been submitted to the Texas Department of Lic sing and Regulation for Accessibility Review.
Control Number: (Not r 'red for 1 &2 family dwellings)
I hereby certify that an asbestos survey has been conducted for this structure in ace rdance with the regulatory requirements of the Texas
Department of Health.
(REQUIRED FOR DEMOLITIONS,ADDITIONS AND OR ALTERATION TO MMERCIAL AND PUBLIC BUILDINGS)
I hereby certify that the foregoing is correct to the best of my knowledge and all work will be erformed according to the documents approved by
the Building Department and in compliance with the City Of Grapevine Ordinance regulating ,as roe on. 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 Gra evine. I FURTHERMORE UNDERSTAND
THAT PLANS AND SPECIFICATIONS ARE NOT REVIEWED FOR HANDICAPPED ACCE IBILITY BY THE CITY,AND THAT THE
DESIGN PROFESSIONAL/OWNER IS RESPONSIBLE FOR OBTAINING SUCH APPROVAL OM THE APPROPRIATE STATE AND
OR FEDERAL AGENCY(S).
PRINT NAME:__DA1V a O Mph4lCpo6 a SIGNATURE
PHONE#:9Rt%00kt!&A* EMAIL:
i3jrF.L89.S34S ❑ CHECK BOX IF PREFERRED TO BE CONTACTED BY E-M IL
THE FOLLOWING IS TO BE COMPLETED BY THE BUILDING INSPECTION DE RTMENT
Construction Type: Permit Valuation: $ Setbacks Approval to Issue
Occupancy Group: Fire Sprinkler: YES NO Front: Electrical
Division: Building Depth: Left: Plumbing
Zoning: Building Width: Rear: Mechanical
Occupancy Load: Right:
Plan Review Approval: Date: -Building Permit Fee:
Site Plan Approval: Date: Plan Review Fee: plq
ire Department: Date: Lot Drainage Fee:
(� Public Works Department: Date: Sewer Availability Rate:
Health Department: Date: Water Availability Rate:
Approved for Permit: Date: Total Fees: tv x
Lot Drainage Submitted: Approved: Total Amount Due:
Pc BOX 95104,GRAPEVINE,TX 76099(017)410-3165 0'.FORMS➢SPERMITAPPLICATION5 W2-Rev 11/04 5IW.110"7.11109.4/11