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I <br /> Mailing <br /> Address;: <br /> <br />Site No ~ <br /> <br />C~ ~,traet:: <br /> <br />Total # Spaces: <br /> <br />lAmhlteet/Englnee¢: "- <br /> <br />Phone; <br /> <br />~dres~; <br /> <br />Type of Re~rmit;; j New:; [] Addition: 0 Demo: <br />~_--"~'~L.. AIt~; 0 Relocation~ O Occ Chg.: <br /> <br />~ Home J <br /> <br />[] <br /> <br />[] <br /> <br />Use of IBuilding: j RES <br />Sq, Ft, Garage: Other <br /> <br />Ft. 2nd FlOOr; <br /> <br />O~upancy: <br /> <br />Proposed Sepflo Irm'mllatton: <br /> Previous ~ite Evak~atlOn #: <br /> <br /> bu~, <br /> <br />C~cupe, nt Load,, V~,ter Supply;: <br />......... ~ <z,Y_ <br />Valuatlom <br /> <br /> B~g. ~e <br /> ~lle Home ~: ..... <br /> ~ Su~a~ <br /> Z~i~ Su~ha~e;: <br /> S~ Surcharge;; <br /> PI~ C~ ~ ..... <br /> Site Evalua~on ~e <br /> ~ ~rm~ F~: ~- ~ <br /> <br /> T~nical R~i~ <br /> <br />invesJigation Fee;; <br />City <br /> <br />TOTAL <br /> <br /> <br />