HomeMy WebLinkAbout017-280-012BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
Website: www.buttecounty.netldds
"PLEASE PRINT CLEARLY*
CONTRACTOR
OWNER
Last Name .
City }lt C-`@
irst Name
Address 4 Od1 I<
t E
City C P(/ C D
zip 9 ��
tate
Fax
Phontf3 _ S Z
Lic. #
Fax
E-mail
Date Approved:
CONTRACTOR
NameO
Name GK -A2-b LIV/Aj7-mC
City }lt C-`@
Address
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City �� tC-�
State nq
zip 9 ��
Phone _(D
Fax
E-ma'I
Lic. #
Lot #
Class
341
ARCHITECT/ENGINEER
NameO
Address r 3 A 8,/W�? Ut
City }lt C-`@
State,
Zi
Phone (/
Fax 64yD&3-6
_E-maiJl
t (UI ,
State License Number
&yzIz6
APPLICANT NAME
Name ►2 _ t� /-1 t�
Addre-st-sem'--
63516,- c5
City C''t I` C -D
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Statee,\
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Phone
Fax 'SIt
E -mai & I n1'-7�4 I V N r� AOL • C UMb.�C
APPLI ANT SIGNATURE
X l�
For office use only:
Zoning
Property Address
�lS K-
Flood Zone
Cross Street
5S LJ A
t (
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
6-5-62—
BP
-5-62—
BP
BIN #
G//- U-0/2LOCATION
AP#— ���
Property Address
�lS K-
Cit
�(�
Cross Street
5S LJ A
t (
WORKER'S COMPENSATION
Policy Number 1</�) ((5--Dy3
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
L&NDING AGENCY
Name
Address
Description or Scope of Work:
,L1�sTA!►ftT/y � >� 1rJp��vc'nll �►ra-�� 1.b1
Sq. Footage -
❑ Structure Built without Permits
❑ Proposed Change of Occupancy
(Note previous use):
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one
year after the date of application. In order to renew action on an
application after expiration, a new application, plans and fee will be
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who
paid the fee. The request must be made prior to the expiration of the
permit and no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not
refundable.
y l/� UJ
Received b : - Amount: Bldg
SRA
Receipt #: i,� / Sheriff
(?04 � SMIP
Date Other
_ Total
REV 7-27-04
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