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Fi0t4E OWNER <br />' <br /><_ <br />APPLICATION FOR RESIDENTIAL 6UILDING & MECHANICAL PERMIT <br />DATE __ _------- <br />, � — <br />/�l'/-;�L �% �1.�� ,: , , PHONE/=-�l <br />, � <br />��^' i;� �� i i CITY! �, ZIP � �- <br />� �! PNONE � " ' <br />CON7RACTOR � � ��: ,�� ��- /, r',�, � r�.: -'7� , <br />� , ` <br />pDDRESS � �n ����f ��, CITY� ., i�,, �:�,,�'-; <��"-, ZIP ;". <br />CONTRACTOR'S STATE LICENSE NO# SEPTIC PERMIT <br />ADDRESS OF JOB - �/-'ii � r _ CITY �.� � ; � T% <br />—JT ' WIDTH Of RUAD <br />TYPE OF WORK �i'/I';''', �-�'%. %� DRIVEWAY FcRMI�— <br />SUDDIVISION OR SHORT PLAT _ SEC TwP RGf. <br />ZONING BLK_ LOT. OR PFrZCEL LOT SIZE_ <br />h1ETES OR BOUNDS <br />16th# <br />�, �i� ' <br />ACCOUNT NO# � "''� % - ' =' l " � : ' - <br />GTHER btIILDINGS ON THIS PROPERTY _— <br />SET9Al."<S: RONT DITIONAL LOT REQUIREMENTS: <br />fur office �SIDE_ IS THE AVERAGE SLOPE OF THE PROPERTY <br />use only REAR __ IN EXCESS GF 25Y? YES NO <br />4l1ILUING DIh1ENSI0NS: ADDITION � REMODEL YES <br />MAiN fL00R1� o�'i (i°�� AIN FLOOR SQ. FT. STORIES BSMT � ��0 <br />SECOND FLOOR SECOND FLOOR SQ. FT. GARAGE _ <br />CARPORT SQ. FT. IN DASENENT(INCLUDE GARAGE IF LOCAT[D IN BASEMENT <br />4ASIC PLAN N0� THE ABOVE PROPOSED STRUCTURE IS TO BE USEG FOR THE FOLLOWIPIG PUR- <br />POS� <br />NAS CONSTP,UCTION STARTED? PLEASC CHECK ONE YES NO <br />b1ECHANICAL PERMIT: OIL GAS ELf.CTRIC LPG <br />N0, TYPE OF EQUIPMENT F[E <br />SIGNED: CONTRACTOR <br />Forced air systems , <br />BTU KW y�� OWNER _. <br />Floor <br />BTU <br />Wall <br />BTU <br />rnaces <br />� <br />Roof Units <br />BTU <br />Fuel Sto age Ta s <br />Size i 9allons <br />�ni b Heaters <br />BTU' KW <br />Air Condition Units <br />H.P. Each <br />Gas fired A.C. Units <br />Tonnage Each <br />Misc. <br />Permit <br />Total Due <br />5 3. <br />FOR OFFICE USE ONLY: <br />VALUATION �'' � ; �� C� c � <br />PLAN i,HECK FEE <br />�=r-�� . - G' �' <br />BUILDING PERMIT FEE : , <br />, <br />MECHANIC,;L PERMIT FE <br />TOTAL DUE <br />�UILDING PERI�IIT N0. <br />?�OTE: PLA�� CfIE�Y. FEE h1UST QE PAID blHEN PLAPdS <br />ARE SU614ITTED <br />