HomeMy WebLinkAboutSFRA2017-2960 AUG 42017 A-UG 22 201 .
DATE OF ISSUANCE: ,
r x x a s PERMIT#: q6 (�
BUILDING PERMIT APPLICATION
(PLEASE PRINT LEGIBLY-COMPLETE ENTIRE FORM)
JOB ADDRESS: 1 t,j j � 1(1 Ilie4ciA r r SUITE #
LOT: BLOCK: SUBDIVISION:
BUILDING CONTRACTOR(company name): PZ;nD 0nY_% "4ra c rC n6 _ f
CURRENT MAILING ADDRESS:
CITY/STATE/ZIP: mCkAx n a,,, .'k _PH:# Z I LI—V 0 C Fax#
PROPERTY OWNER: gtvloj Skn"e:
CURRENT MAILING ADDRESS: t \I al iL
CITY/STATE/ZIP: a v o PHONE NUMBER: Z)'-I— 357 7AD
PROJECT VALUE: $ FIRE SPRINKLERED? YES NO Y
WHAT TRADES WILL BE NEEDED?(Check ones that apply)ELECTRIC PLUMBING MECHANICAL
DESCRIPTION OF WORK TO BE DONE: !)
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 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 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 AGENNCY(S).
PRINTNAME: 1�tgCll%�Uu`' � �0 SIGNATURE �!�
PHONE#: \l �— v�l� [{ EMAIL:
❑ CHECK BOX IF PREFERRED TO BE CONTACTED BY E-MAIL
THE FOLLOWING IS TO BE COMPLETED BY THE BUILDING INSPECTION DEPARTMENT
Construction Type: \J13 Permit Valuation: $ 7 4 So -CC Setbacks Approval to Issue
Occupancy Group: 3 Fire Sprinkler: YES — NO— Front: — Electrical —
Division: Building Depth: Left: Plumbing —
Zoning: (7 Building Width: — Rear: — Mechanical —
Occupancy Load: Right: "
Plan Review Approval: Date:Z{ •11 • \ Building Permit Fee:
Site Plan Approval: Date: Plan Review Fee:
Fire Department: Date: Lot Drainage Fee:
Public Works Department: Date: Sewer Availability Rate:
Health Department: Date: Water Availability Rate:
Approved for Permit: Date: $ 11-%'j Total Fees: 3 ?, ;Z S
Lot Drainage Submitted: Approved: Total Amount Due: ( 3/,,2 5
PO.BOX 95104,GRAPEVINE,T%]6099(917)0103165 OSOBMSIDSPERMITAPPLICATIONS14j(/lIM�6. 711N9.1(y1 ^
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