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· . ,~ 1,?;;~ 9 ' g Left Right ' <br /> <br />Property Owner: ~.~,t,~.~,~.A.~ t!'~,~ .......... Phone; Mailing Address: . <br /> <br />Job Address; u Site NO.: <br />.~.~ ~ ~ Property Tax Lot No,: Fleet 8/C ~e: <br /> ooo ............. <br /> Acre~: Irreg. L~:Corner: <br />Lot Width', ~t Depth: <br />ff~ ~ ~ ...... ~ ~ ........... <br /> <br />Contractor Business Name and <br /> <br />Architect/Engineer: <br /> <br />Phone: <br /> <br />Phone; <br /> <br />Type of Permit: New: <br /> Alter: <br /> <br />~ AdditiOn; [] Demo: [] Tach. <br />[] Relocation: [] Ccc, Chg,: [] Review; [] <br /> <br />Height of Building; NO. Stories: Sq. Ft, Main Floor: Sq, Ft, 2nd Floor; <br /> <br />Mobile Home Mobile Ho~ne ~ Bedro'Oms; Occupan~cy: <br />Width: Length; <br /> <br />Use of Building'. <br /> <br />RES ~ <br />COM [] <br /> <br />Sq. Ft. Garage: <br />Occupant Load: <br /> <br />Other: <br /> <br />Wate~ <br /> $ <br /> <br />Proposed Septic Installation; <br />Previous Site Evaluation #: <br /> <br />Date Tank Pumped; Existing Bedrooms; <br /> <br />I have read this application in its entirety and certify that the stated Information is <br />true and correct to the Pest of my knowledge. <br />I ~m performing work on a property I own or occupy. <br /> <br />OTHER PERMITS REQUtRED BY THIS DEpT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev. 12/87 <br /> <br />Valuation: <br /> <br />Bldg. Fee: <br />Mobile Home Fee: ~'~ <br />Fleet Surcharge: <br />ZOning Surcharge; ~"~ <br /> 3, <br />State SurCharge: <br /> <br />Plans Check Fee: <br />Site Evaluation Fee: /~ <br />Septic Permit Fee'. <br />DEQ Surcharge: <br />Technical Review Fee; <br />Relnspectlon Fee; <br />Investigation Fee: <br />City Fee: ' [, <br />TOTAL FEE: <br />RECEIPT NO.; ~;:~J/'L~. <br /> <br /> <br />