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rrra.QI o ?.I <br />of <br />Type <br />Occupancy <br />Height <br /> n <br />Construction Group in Feet <br />PERMIT o <br />Sq. <br /> <br />No g <br />f Feet Stories No. of . of <br />Setbacks of Building Living Units <br /> Front: Rear: ? <br />Applicant Name: Left: Right: <br />Water: PIF <br />Date Paid <br />Amount <br /> <br />A <br />li <br />n <br />Date: <br />ti <br />pp <br />. <br />ca <br />o 191104 V %I • Ta <br />Fee <br />/ <br />t p <br />Date Approved: <br />u Floor Area: Value: Tap. Insp Chrg <br />Date Iss <br />ed: T <br />Th <br />f <br />{ Oversize Fee own o <br />e <br />Expiration Date: 180 Days from Issue RWA Fee Bennett <br />Job Address <br /> W.M.W. Rdout. <br />.,_.t . ft, ..._. ?n..r. Other <br />Phone Total Total <br />Owner Address <br /> <br />a? • <br />I. Paid Date Initials <br /> RECORDS: N/A Attached Buildin <br />Permit Fee <br /> g <br />; <br />4F, t t Phone PUBLIC WORKS: <br />Plan Review Fee <br /> <br /> <br />Contractor TREASURER: Use Tax <br /> WATER & SEWER: Water Department TOTAL <br />Contractor N PLANNING & ZONING: Sewer Department TOTAL <br />Architect FIRE DEPARMENT Excavation Permit Fee <br /> POLICE DEPARTMENT: Demolition/Moving Permit Fee <br />Phone IKEA Electrical Permit Fee <br />Engineer <br />CABLE <br />General Service Fee <br /> TELEPHONE Street Oversizing Fee <br />Phone ECUC Parks & Recreation Fee <br />Legal Description <br /> Culture Fee <br /> Ila <br />Use of Bldg. <br />Sewer PIF Date Paid Amount <br /> Tap Fee <br />Ge al escr' ion of Work 'r IV Tap. Inspec. Charge TOTAL <br />q Oversize Fee <br /> <br /> I hereby acknowledge that the above information is true and <br /> correct. <br /> Signature <br />.+ ie - oununiy r no 1 OIruW - riartimiu rue -in - ?uumv m53e3sur ureen - ri- UBni RalnaMa,,l - P-if