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, <br /> fiPPLICATION FOR RESIDENTIAL BUILDING & MECHANICAL PERMIT <br /> DATE d' - � `�- %S' <br /> HOME OWNER , j ;� Y e L iJ �d_ Gt N G 5 T,�Li PHONE <br /> !. .cESS ,39n1 �riDu� ,4°�ir CITY Ev� Y.�Tj ZIP yd'aa / <br /> CONTRACTOR�2�_.� /� iTu iv ,r c � PHONE �S� 7C- 6 d' <br /> T—' <br /> ADDRESS 3,f`c„? f"y �Aiay �yd .� CITY E�crcT% ZIp <br /> CONTRACTOR'S STATE LICENSE NON �� -�( -�vn� - .?2 7/r y SEPTIC PERMIT <br /> ADORESS OF JOB ,�9e � � v .1»a>' .Q v c CITY G=v�• Y� TT <br /> WIDTH OF ROAD <br /> TYPE OF WORK ,C3ri c (c /Q e Pa� r S i� i'r. nRIVEWAY PERM <br /> L G L D SCRIPTIO : <br /> SUBDIVISION OR SHORT PLAT � SEC �'�� TWP �'_' " RGE S <br /> ?JNING BLK LOT OR PARCEL LOT SIZE " 16thN <br /> MEfES OP. BOUNDS <br /> ACCOUNT NO#��yo y- Mo i- a�i_a p c � <br /> OTHER BUILDINGS ON THIS PROPERTY � LG l-(,.��i <br /> SETBACKS: RONT ITIONA_ LOT REQUIREMENTS: <br /> fr� office SIDE IS THE AVERAGE SLOPE OF THE PROPERTY <br /> � only REAR IN EXCESS OF 25%? YES NO <br /> BUILDING DIMENSIONS: ADDITION REMODEL <br /> YES <br /> MAIN FLOOR MAIN FLOOR SQ. FT. STORIES BSMT' � NO <br /> SECOND FLOOR SECOND FLOOR SQ. FT. GARAGE <br /> CARPORT SQ. FT. IN BASEMENT(INCLUDE GARAGE IF LOCATED IN BASEMENT <br /> BASIC PLAN NON THE ABOVE PROPOSED STRUCTURE IS TO BE USED FOR THE FOLLOWING PUR- <br /> POSE <br /> HAS CONSTRUCTION STARTEDI PLEASE CHECK ONE YES X NO <br /> MECHANICAL PERMIT: OIL GAS ELECTRIC LPG <br /> N0. TYPE Of EQUIPMENT FEE - <br /> SIGNED: CONTRACTOR%�,_,//� ��.,,LL, <br /> Forced air systems �_ <br /> BTU KW � OWNER__ � <br /> loor Furnaces _ <br /> B U KW <br /> FOR OFFICE USE ONLY: <br /> Wall Heaters <br /> BTU KW VALUATION �, j��n , CC7 <br /> , <br /> Rouf Uni PLAN CHECK FEE <br /> BTU KW <br /> DUILDING PERIdIT FEE <br /> Fuel Storage anks <br /> Size in gallon <br /> - MECHANICAL PERMIT FEE <br /> Unit Heaters <br /> DTU KW TOTAL DUE <br /> Air Condition Units <br /> H.P. Each_�_ <br /> BUILDING PERh1IT N0. <br /> Gas Fired A.C. Units <br /> Tonnage Each <br /> NOTE: PLAN CHECK FEE MUST BE PAID WHEN PLANS <br /> Misc. � ARE SUBh11TTED <br /> Permit $ 3.00 <br /> Total Due $-- <br />