Building Inspection 
P.O. Box 9010 
Addison, TX 75001 
972.450.2880 
Date: i 
Permit # 
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TOWN OF ADDISON 
BUILDING PERMIT APPLICATION 
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Construction Address: 
Suite Number: 
Subdivision: 
14'f'11 Z e 
Lot' 
Block 
Building Owner: 
Phone _ 
Meiling Address:Zi 
Cit y f . 
St e: 
�1 p: 
General Contractor: 
Addison Lic. No: 
Phone: 
Mailing Address: 
City: 
State: 
Zip: 
Plumb! Contractor: 
Addison Lic. o: 
Phone: 
Ili ng Address. 
c: 4 
Ciy: t 
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Sta o: 
Zip:, �.._ 
Mechanical Contractor: 
Addison Lic. No: 
Phone: 
Mailing Address: 
City: 
State: 
Zip: 
Electrical Contractor: 
Addison Lic. No: 
Phone: 
Mailing Address: 
City: 
State: 
Zip: 
Irrigation Contractor: 
Addison Lic. No: 
Phone: 
Mailing Address: 
City: 
State: 
Zip: 
NOTES: I 
An asbestos survey has been conducted inaccomance with the Texas Asbestos Health Protection RulaeTAHPR) and the National Emmission Standards for Hasa fou3 Air Pollutants (NE 
for the areas being renovated emitter demolished. YES — No_ 
• If the answer is No, then as the owner/operator of the renovatioNden clition site, I understand that it is my responsibility to have this asbestos survey conducted in accordan the Texas 
Asbestos Health Protection Rules (TAHPR) and the National Emission Sumitomo for Hazamous Air Pollutants (NEsHAP) prior to a s movationldemutition meant being issued by the Town. 
T:A.S.# By: kPR 1 6 20P9 
DATE ISSUED: 
[ ] New Bid. / 
[ ] Int. Completion 
[ ]Addition 
[ ] Repair 
[ ] Int. Remodel 
Date: of Application: 
[ ] Ext. Remodel 
[ ] Pool 
[ ] Irrigation 
[ ] Other (Explain) 
Estimated': Evaluation: 
Size Number Gas In 
Water Meter Building 
Sewer Tap [ ]Y [ ]N 
NU I 1Ut1 u APHLIUAN lar"is permit is issued On the basis at information mutinied In give apple aVoOane on any submitted plans.ana rs to me 
previsions and requirements of the Town of Addison Code of Ordinanaces and any other applicable ordinance. This permit is issued only for the ] 
purpose of allovang construction conforming to the codes andordi nces of the Town, regardless of information and/or plan submitted. 
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Payment Type:V{,,��.- Date: ,..t Receipt: ���,