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FOR OFFICE USE ONLY <br />PERMITNUMBER �`rj'j (�-(�jS/ <br />SITE ADDRESS — <br />LOT AREA FRONT SEl'BACK REAR SET�ACK <br />� �02- ao' ao' <br />NO.OF DWELLING APP� BY DATE <br />�N�TS I � tl a(�/v3 <br />ZONING <br />SIDE SETBACK <br />f <br />5���v <br />COMMENTS <br />BUILDING <br />SU�•PERMITS <br />VACANT SITE ' USE ZONE HEIGHT LIMITATION <br />YES NO n�� � <br />� f�.. <br />3LDG�'i.l. SIZE GARAGE SIZE N0. OF OCCUPANCY OCCUPANT BASE�IENT NPE OF CONSTRUCTION <br />STORIES GRGUP LOFD YES NO <br />1�3�s s,F, 4? SF 2 R-3 �iJ <br />NEW FIRE SPRINKLER REASON NEW FIRE ALARM REASON <br />REQ'D REQ'D <br />� <br />A;r- <br />APPRO�I��D Y DATE COM�dENTS <br />1/%2 � 3 <br />VALUATION I3� 03 `J" <br />� <br />oui�oiN� <br />SURCHARGE <br />ADD PLAN CHK <br />� <br />I PLUMBING <br />i <br />IMECHANICAL <br />j SPRINKLE <br />� PUBLIC WURKS <br />I TOTAL <br />PLAN CHECK FEE <br />FEES <br />WATER _ <br />SEWER _ <br />SYS. DEV. <br />TRAFFIC MIT. <br />OTHER <br />TOTAL <br />