Application For Building Permit: Office of The Building Official
Application For Building Permit: Office of The Building Official
2003-001-B
Address
Address Address
CTC No. Date Issued Place issued CTC No. Date Issued Place Issued
BOX 3 BOX 4
BOX 5
BOX 6 (SUBMITTALS TO BE CHECKED, RECEIVED AND RECORDED)
LICENSED ARCHITECT OR CIVIL ENGINEER CTC NO. Date Issued Place Issued
(Full-Time Inspector and Supervisor of Construction
) Works
whose signatures appear hereinabove, known to me to be the same persons who executed this standard prescribed from and acknowledged to me that the
same is their free and voluntary act and deed.
WITNESS MY HAND AND SEAL on the date and place above written.
Doc. No.
Page No.
Book No.
Series of NOTARY PUBLIC (Until Dec. ______)
ASSESSED FEES ASSESSED BY AMOUNT DUE DATE PAID O.R. NUMBER NSO
FILING FEE
PROCESSING FEE
LOCATIONAL/ZONING OF LAND USE
LINE AND GRADE (Geodetic)
FENCING
ELECTRICAL
MECHANICAL
SANITARY
PLUMBING
BOX 7ELECTRONICS
(TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)
INTERIOR BUILDING PERMIT
ONE HALF
BUILDING (1/2)NO.
PERMIT OF FIRE SERVICE FUND (FSF) OFFICIAL RECIEPT NO.
TOTAL
DATE ISSUED DATE PAID
M M D D Y Y M M D D Y Y
NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE "NATIONAL BUILDING CODE"