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� <br />� <br />c��lc�3 ��Y <br />FOR OFFICE USE ONLY <br />BUILDING _ <br />R'dqll I;;.�1dn�Rein Sirr l7Z S <br />����y�: s��� 4P� <br />VALUATION Z 3 <br />hb. of Stories + <br />Basemer! Yes <br />iqpe of ConstruCtion <br />f.zst3 Se'�nk!ei Sys!em� Y�5 <br />F�re Sprink Reqd7 Yes <br />Reason <br />Gxs:g F�re Alarm� Yes <br />P�re Alarm Reqd? Yes <br />Reascn <br />lo XFrt:�Un` <br />� <br />No Unk_ <br />No__, <br />No Unt <br />No <br />CO Required? Yes No _. <br />L-ncloswe �RC'lJ64 55) Yes _/ No <br />Approved by Dalc Y Z-- <br />Comme:,is 20�Z /,eC � {'�✓S�G <br />FEES <br />Pla�i Chetk Fee <br />Hudding Permd <br />Surcharge <br />Adddional Plan ( <br />Systems Dev. Due� <br />F'ubtic Works <br />Traffic Mdiqation Due? <br />PLANNING <br />7anny C'.assdr.afinn � �� <br />OvarlaylAgreericM ' <br />i <br />Nonresidentiai U.e <br />Proposed No. o( Dwe'�Pnq Und;. � <br />7o�al No. of Dc;e!'�ng Unds: <br />Landscapc or Planning Inspection <br />needed belorc (inal? Ye5 No <br />Plannmg Inspector <br />Phone # <br />Approved by Date�3 • I I'� <br />I-Iistor�c ApGrcved ty Date. <br />School F.titigation Reqd� Yes �do <br />CommeNs <br />� <br />_ No <br />� <br />Na <br />ocl F,htiaai;on r'ad° IYes tJu Dale Pd <br />