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•'�IIlt11 5'Y1Vlt JAN 5 2018 DATE OF ISSUANCE:JAN 16 2018
fyC7 PERMIT#:
BUILDING PERMIT APPLICATION
(PLEASE PRINT LEGIBLY-COMPLETE ENTIRE FORM)
JOB ADDRESS: 2 �O �( n[ f/(,vhf [Dr
SUITE#
LOT: BLOCK: SUBDIVISION:
BUILDING CONTRACTOR(company name): 1/131g
pjy
CURRENT MAILING ADDRESS: _yy10 k,) t/. [
CITY/STATE/ZIP: f't"LL✓ (�c -we PH:# �, - Fax#
PROPERTY OWNER: s cmtf2std
CURRENT MAILING ADDRESS:\
CITY/STATE/ZIP: _ G✓✓1(x.tily� �`jC 7/� PHONE NUMBER: 8I7' 7 7J�S
ii < _
PROJECT VALUE: $ y �d� �/�
FIRE SPRINKLERED? YES NO
WHAT TRADES" WILL BE NEEDED?(Check ones that apply)ELECTRIC__ PLUMBING_ MECHANICAL_
DESCRIPTION OF WORK TO BE DONE: I l Gy11 01 >a y
USE OF BUILDING OR STRUCTURE:
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 ac
State Law. Plan review and inspection documentation shall be made available to the Buildi D cordance with
Department(required for new buildings,
alterations and additions) Building
❑ I hereby certify that plans have been submitted to the Texas Department of Licensing and Regulation for Accessibility Review.
Control Number: (Not required for 1 &2 family dwellings)
❑ I hereby certify that an asbestos survey has been conducted for this structure in accordance with the regulatory require
Department of Health. ments of the Texas
(REQUIRED FOR DEMOLITIONS,ADDITIONS AND OR ALTERATION TO COMMERCIAL AND PUBLIC BUH.DIN GS)
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 PLANS AND SPECIFICATIONS ARE NOT REVIEWED FOR HANDICAPPED ACCESSIBILITY By THE CITY,AND THAT THE
DESIGN PROFESSIONAL/OWNER IS RESPONSIBLE FOR OBTAINING SUCH APPROVAL FROM THE APPROPRIATE STATE AND
OR FEDERAL AGENCY(S).
PRINT NAME: �� SIGNATURE
PHONE#: Z7- 34,P
EMAIL:
THE FOLLOWING is 7Yl RF COMPLETED THE u.uuv(a t1vSi'>;LT[ON DEPARTMENT
Construction T e Pernut Valuation. $ b $•00 Setbacks
Occu anc Grou : A roval to Issue
R Fire S rink]er: YES_ N0= Front: -- Electrical -�
Division: Buildin De the Left:
Zonin : 7 S Building Width: — Plumbin
Rear: Mechanical —
Occu anc Load: Ri ht: —
Plan Review A roval: Date: ( • 10 lg Building Permit Fee:
Site Plan A roval: Date: Plan Review Fee:
Fire De artment: Date: Lot Drainage Fee:
Public Works Department: Date: Sewer Availability Rate:
Health Department: Date: Water Availabilit Rate:
Approved for Permit: Date: 1 1 p•) Total
Lot Drainage Submitted: Approve : O M lint e. 9
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IONIC 1119
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