Date: 4 tt _ 6t 
TOWN OF ADDISON 
BUILDING PERMIT APPLICATION 
Permit# ]f .i. 
FOR OFFICE USE OML Y.• 
ZONING: 
OCCUPANCY: 
CONSTRUCTION: 
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Construction Address: 
Suite Number:: 
S bdivision: 
Yt" 
Lot 
'Block 
Building Owner 
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Phone 
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Mailing Address: 
C it : 
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SLate: 
k 
Zip: 
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General Contractor, ,- 
Afton Lic No.. , 
Phone: 
Mailing Address: 
City: 
State: 
Zip: 
Plumbic Contractor: 
L. 
y 
Add o Lic. 
Phone: 
Mailing Address 
t> v, c 
City: 
t . 6t lit ` 
State. 
e 
Zip 
Com; 
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: 
An asbestos survey has been conducted 
in accordance with the Texas Asbestos Health Protection Rules fTAHPR) and the National Emmissmn Standards for Harardous Air Pollulants INESHAP) 
for the areas being renovated andlordemolished. 
YES _NO_ 
• If the answer is No, then as the ownerloperator 
of the renoyatioNdemolition site.I understood that it is my responsibility to have this asbestos survey conducted in accordance with the Texas 
Asbestos Health Protection Rules ITAHPR) and the National Emission Standards for Hazardous Air 
Pollutants (NESHAP) priorto a renovatiouldrawfirion permit home issued by the Tovm. 
T.A.S.# 
By: 
y 
�7, 
bi-4 T` - 
Irl 
PERMIT TOTAL: $ 
DATE ISSUED: 
Work Being Done: '' f 
Area 'i Squa esFeet 
Use of Building: 
[ ] New Bid. s 
[ j Ext. Remodel 
Estimated Evacuation 
[ ] Int. Completion [ ] Pool 
[ ]Addition 
[ ]Irrigation 
Utility Information 
Na'of:Tenant. 
[ ] Repair [a�]'6ther (Explain) 
-- size Number Gas in 
Ipnt. Remodel 
a __ eter Building 
dd 
4� 
[ ]Y [ IN 
Date of Application: — 
sant [efi 
signature: 
provisions and requirements the To Id f aces and any other applicable ordinance. This permit is issued only for the 
purpose ofallowing conshcoio c eland aces of the Town, regardless of information and/or plans submitted. }( n�9 
APR 16 2619 �( 
Off'ce Use Onl 
�. 
"`'r Payment Type: C '. Date• Receipt:` y