14A RUSSELL DR - BUILDING INSPECTION What is tM rxxrent use of the SuiidhV?
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va Iha a dWV Conform to Law? AebptosT
The Chimney Guys
ArchNmt*Name ox t
AddrNs and PhwW ♦ n �Ln
LAeddes Noma 78-97 -9900
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Address and Phone HIC PAQWVSdon
supervisorsConabuelionsupervisors
Estimated Cost a Pro1" Perna Fee Caladatloo
Penn&Fee= Estimated Coat X:7/:1000 Reaidwdlsl
Edbu tad Coet X:11l:1000 Commercial
An AddNWW$5.00 is added as an
Administrative dwgs. —
Make sure that all flelds are properly and Isobly wttten to avoid delays In Proeeaslnp. .
The und.Wned does hereby apply for a Buildup Permit to to the a atatad
speclllogd na, sW wd under PwMft of 138"
oats
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EPTY"Orl ingm
4 PUBLIC PROPERTY
,a DEPARTMENT
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A_ppLCATION FOR THE RB_pA_UL RE_rIOVATiAN_ CnrrMUCTjQ
DuNIOLMON,OR CHANGE OF U3E OR OCC PANc'v Fog .NV F.YiRMG
`ter
$TRQCI'U — OR BUII.DINQ
1.0 SM INFORMATION
Load= Name: BuNdlna
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Addreswjq—_A- _ . sue// r.
Property k/bcabd M a;Carenati0n Anw YM�L Hkgoris Olstld YM
2.0 OWNERWIP INFORMATION
L1 Owner of Laird
Nam4K
Addresc
TOM~.. gr 77� 96�
O.000MPLETE THIS SECTION FOR WORK IN Ex!>fllNp 9(ALMNGs ONLY
Addition Existing
Renovation Number of Stories Renovated
F
se New
Existing
e year of Area per floor (sf) Renovated
or renovation uilding New
ption of Proposed Work:
--- -- ---Mail Permit to: - - -