Building Inspection 
P.O. Box 9010 
Addison, TX 75001 
972.450.2880 
Date' 
TOWN OF ADDISON 
BUILDING PERMIT APPLICATION 
Permit # 12�2,C; (cl - U, . 0 1 
FOR OFFICE USE OK Y.' 
ZONING: 
OCCUPANCY: 
CONSTRUCTION: 
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Construction Address: i 
Estimated -Evaluation: q, €? 
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Suite NumbeC. 
Subdivision: 
Utility Information 
Size Number Gas In 
Water Meter_ Building 
Name o#Tenant: 
(Remodel -h 
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Lot 
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General Contractor: 
Addison Lic. No: 
Phone: 
Mailing Address: 
City: 
State: 
Zip. 
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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 nrAHPR) and the National Emmission standards for Hazardous Air Pollutants (NESHAP) 
for the areas being renovated and/or demolished. YES-- NO 
• If the answer is No, then as the ownerloperator of the renovation/derrimhon site, I understand that it is my responsibility to have this asbestos survey conducted in accordance with the Texas 
Asbestos Health Protection Rules ITAHPRI and the National Emission standards for Hazardous Air Pollutants (NESHAP) prior to a renovation/demolition permit being issued by the Town. 
T.A.S.# By: 
PERMIT TOTAL: $ t 
DATE ISSUED: 
[ ] New Bid. [ ] Ext. Remodel 
Estimated -Evaluation: q, €? 
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[ ] Int. Completion [ ] Pool - 
[ ]Addition [ ]Irrigation 
[ ]Repair [i -]`Other (Explain) 
[ ]Int. 
F'>tck t t: rt 
Utility Information 
Size Number Gas In 
Water Meter_ Building 
Name o#Tenant: 
(Remodel -h 
t'. ' P rk Cwt~. �' �f :.t , `'i T, 
Sewer Tap I lY [ ]N 
Date of Application: 14 ^ iL—( of Signature: 
NOTICE TO APPLICANT This ermiI is issued on the basis dinfomtaten furnished in this application and on any §Gljmitted 0141S. and is to the 
provisions and requi men f e: o eof Ortlinanaces and anyeiher applicable oMinance.Th ermit is uetl only for the ..��--rr [ 
purpose of allowing manic conro g i sadden nd ordinances of the Town, regardless of information and/or plans submitted. "E iu 
FT6 $ as, ✓ cf"”" 
APR 16 2019Office Use Onl 
Payment Type: �.. Date: ,_C Receipt: 'pry (;