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� - <br />HOME OWNE <br />- -- i z/�'/�' <br />APPLICATION FOR RESIDENTIAL BUILDING & MECHANICAL PERMIT 3�G 2 <br />DATE���G�-ti'' � � <br />lJ,...,�.- .i�T/-�1=1 G �n�1�)%n.RF.� A� �.rl>2ii/�,� PHONE,7.5�-�ar%�'. <br />ADDRfSS f�� �� /i !9 INIL R f� V� CITY�� 1/G/���T ZIP 2D <br />CONTRRCTOR � <br />ADDRESS <br />PHONE <br />ITY ZIP <br />CONTRACjOR'S STATE LICENSE N0� SEPTIC PERMIT <br />ADDRESS OF JOB CITY <br />WIDTH OF ROAD <br />TYPE OF WORK �RIVEWAY PERM <br />G DESCR PTIO : ` v F�. � j T fI � V <br />SUBDIVISION OR SHORT PLAT P,�'� fl' % O F SEC TWP RGE <br />�oTS <br />ZONING BLK�_LOT OR PARCEL� w-Qyj LOT $IZE 16thN <br />METES OP. BOUNDS <br />ACCOUNT NONG�3 �.0 �3�.5-�� 7-Ooa a. <br />OTHER BUILDINGS ON THIS PROPERTY �! B Z� S F ' <br />SETBACKS: �RONT <br />for offi;e REAR� <br />use only • <br />BUILDING DIMENSIONS: <br />MAIN fL00R G f� M/�'.�N � MAIN FLOOR SQ. FT. <br />�Q,�TIONAL LOT REQUIREMENTS: <br />IS THE AVERAGE SLOPE OF THE PROPERTY <br />IN EXCESS OF 25%4 _S NO <br />ADDITION REMODEL YES <br />STORIES BSti� NO <br />SECOND FLOOR SECOND FLOOR SQ. Fi. GARAGE <br />CARPORT �� . FT. IN BASEMENT(INCLUDE GARAGE IF LOCATED IN BASEMENT <br />BASIC PL NOM THE ABOVE PROPOSED STRUCTURE IS TO BE USED FOR THE FOLLOWING PUR- <br />POSE �/'i- .% <br />HAS CONSTRUCTION STARTED? PLEASE CHECK ONE YES � NO <br />MECHANI <br />N0. <br />� <br />: OIL 6AS <br />TYPE OF EQUIPMENT <br />Forced air systems <br />BTU KW <br />floor Furnaces <br />BTU KW <br />Wall Heaters <br />BTU KW <br />Roof Units <br />BTU KW <br />Fuel Storage Tanks <br />Size in gallons <br />Unit Heaters <br />BTU KW <br />�Air Condition Units <br />H.P. Each <br />Gas Fired A.C. Units <br />Tonnage Each <br />Misc. <br />� j Tota <br />FEE <br />� <br />ELECTRIC LPG <br />SIGNED: CONTRACTOR <br />NOTE <br />OWNER <br />FOR OFFICE USE ONLY: <br />VALUATION <br />PLAN CHECK FEE <br />BUILDING PERMIT FEE <br />MECHANICAL PERMIT FEE <br />TOTAL DUE <br />BU.LDING PERMIT N0. <br />PLAN CHECK FEE MUST BE PAID WHEN PLANS <br />AR[ SUBMITTED <br />