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_ . . � <br /> 1 <br /> 3� 1 DI71 APPLICATION fOR RESIDENTIAL BUILDING & MECHANICAL PERMIT 1 <br /> � I3 DATE L�L�c ;�9 I`�"I'7 <br /> HOME OWNER���� WG��51�r��w�-- PHONE 2� � J ' <br /> ADDRESS .�oS' �k n_.�c,c.,;.�� CITY �c�C�°�-� ZIP `t`���c� � <br /> CONTRACTOR da'�/��K� i PHONE J <br /> ADDRESS CITY ZIP , <br /> CONTRACTOR'S STATE LICENSE NON SEPTIC PERMIT <br /> I <br /> � <br /> ADDRE55 OF JOB .ZG S� ,J.SL.���•:� / CITY •r.-�:,�,� �,_i�s� <br /> WIDTH OF ROAD � <br /> TYPE OF WORK �%tc�i��-� C��czf�nvl� �;��'.c -�Lc�z+�a� � t1RIVEWAY PERMT'�— <br /> . <br /> CEG11 D SCRIPfiION: �-�7�, � �/ ) �f�j ' ' <br /> SUBDIVISION OR SHORT PLA<T�,�T �2,� 1 /.C�/ I`t`�/ SEC TWP RGt ' <br /> —� � *f: — <br /> ZONING BLK LOT OR PARCEL___?�LOT SIZE 16th# � <br /> METES OR BOUNDS <br /> ACCOUNT NOt! ;d.i= ; -(_�rJ!) -T}y4-0(�0'T <br /> OTHER BUILDINGS ON THIS PROPERTY t�lc�r�ti_ <br /> SETBACKS: �RONT DITIONAL LOT REQUIREMEtiTS: <br /> for office SIDE IS THE AVERAGE SLOPE Of THE PROPERTY <br /> use only REAR IN EXCESS OF 25%7 YES NO <br /> BUILDING DIMENSIONS: ADDITION REMODEL YES <br /> IdAIN FLOOR �U � .�J�SC � MAIN FLOOR SQ. FT. STORIES B�l4T' ' NO <br /> SECOND FLOOR SECOND FLOOR SQ. FT. GARAGE <br /> CARPORT SQ. fT. IN BASEMENT(INCLUDE GARAGE If LOCATED IN BASEMENT <br /> BASIG PLr,N NON THE ABOVE PROPOSED STRUCTURE IS TO BE USED FOR THE FOLLOWING PUR- <br /> POSE <br /> HAS CONSTRUCTION STARTEDI PLEASE CHECK ONE YES Y NO <br /> MECHANICAL PERMIT: OIL 6A5 ELECTRIC �: LPG <br /> N0. TYPE OF EQUIPMENT FEE <br /> SIGNED: CONTRACTOR <br /> �FTUced air syKWems OWNER � � „�,. � <br /> ��-�,/,��_ <br /> � -� <br /> ! l �• <br /> Floor Furnaces ` '� <br /> BTU KW <br /> FOR OFfICE USE ONLY: <br /> Wall Heaters <br /> ' BTU KW�_ VALUATION `j��S , <br /> Roof Units PLAN CHECK FEE <br /> BTU KW CrU <br /> BUILDING PERMIT FEE G- — <br /> Fuel 5torage Tanks <br /> Size in gallons <br /> MECHANICAL PERMIT�FEE <br /> Unit Heaters ' tY,� <br /> BTU KlJ TOTAL OUE �. -� <br /> Air Condition Units <br /> H.P. Each <br /> BUILDING PERMIT N0. <br /> Gas Fired A.C. Units <br /> Tonnage Each <br /> NOTE: PLAN CHECK FEE MUST BE PAID WHEN PLANS <br /> Misc. ARE SUBMITTED <br /> Permit 3.00 <br /> Total Due <br />