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FOR OFFICE USE ONI Y <br />PERMIT NUMBER L J I I-V ��� <br />SITE ADDRESS <br />LOT AREA FRONT SETBACK REAR SETBACK <br />5 �Qs �� Zv� <br />NO. OF DWELLI�G ��AP..qP�RyyOVED BY DATE <br />UNITS � � I��2�OS <br />ZONING <br />SIDE SETBACK <br />� <br />COMMENTS <br />BUILDING <br />,� <br />SUB-PERMITS <br />VACANT SITE I US�ZONE I HEIGH�TATION <br />YES NO � � <br />v�n <br />BLDG/T.I. SIZE GARAGE SIZE N0. OF OCCUPANCY OCCUPANT BASEMENT TYPE OF CONSTRUCTION <br />2l ! S S�Z STORIES GR� u LOAD YES NO � <br />NEW FIRE SPRINKLER REASON NEW FIRE ALARh7 REASON <br />REQ'D REQ'D <br />APPROV� OATE COMMENTS Z oa3 ! C' �.�V�i4 Q� <br />�2 % bOp .r,�^C <br />VALUATION I g6� 5�70 <br />BUILDING <br />SURCHARGE <br />ADD PIAN CHK <br />PLUMBING <br />MGCHANICAL <br />SPRINKLE <br />PUBLIC WORKS <br />TOTAL <br />PLAN CHECK FEE <br />FEES <br />WATER �� <br />SEWER %� <br />SYS. DEV. �� 1� lD� b <br />TRAFFIC MIT. <br />OTHER <br />TOTAL <br />Z'� <br />