HomeMy WebLinkAbout1811 GUEVARA RD; ; 62-5014; PermitAPPLl:Tl:N=~~~w!~~!c,=,~,lf i/! 5014
~i:::. ~~;~f) <Jai~--~;;:~:-~-~:~~j-----------Moiling Address~~~:-!-7../J.#.51~?1,.---~--------~!
Contractor -·········--~---·················································-·····Mailing Address-·-···--·~-~---······································ ( Please Print) Number Street City Phone
To Construct~ Add D To Alter D To Repair D To Convert D To Move From ............................................................. .
Type of Con,t~~JGnd of Foundation ___ ~,,----No_ of Storie, ____ / ______ To Be U,ed for -----~-------------------------
(Frame, Masonry, Etc.) !One Family Dwelling, Store, Etc.)
Floor Space of Propo,ed Con,truction (sq_ feet) ----_/ lJ../ ~--______ Con,t. Valuation $_ ----~ --____ 9 _ ------3'-fl.il-----------------------------------------·
Floor Space of Garage (sq_ feet) __ -----__ -----L/.~-7 _______ J:::~:~ Bcon,t_ Valuation $ z. ___ -:...:~--------= __ ------------------------·----------------------------·----
LEGAL DESCRIPTION --------------------~---~------------------------------------------~ _____ /3f'l.../k1... ___ {:i. __ Z __________________________________________________________ _
lot Block Subdivision
or ---------------------------------------------------------------A-----------------------------------------------------------Sectlon ___________ ~, . T_;.wn~ /1-------Rang•---------------------···----
Loeated at ............... /$../L~---··-···-··········-Street, Near .................. ~ ............................................•.•..•
Assigned House Number
LAND AREA -------------------------------------NUMBER OF EXISTING DWELLINGS ON PROPOSED BUILDING SITE ----~------(INDICATE
SIZE, USE AND LOCATION ON PLOT PLAN). WILL THIS CONSTRUCTION INCLUDE ANY PLUMBING INSTALLATION, ALTERATION, OR
ADDITION? YES---~ NO----------------•
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
If o check is tendered for p·oyment of the above fee and the check is
not honored when presented for payment, your Building Permit will be
immediately revoked.
SIGNATURE OF
PERMITTEE -------------------------------------------·---·---·---------------------------------------·-··
I' •
Front Yard Set Back ... d.0 ................. = Driveway Permit Required Yes ( ) No ( f,,:;. --------------------------------------
Side Yard Set Back ........... 8.. ... ~·-···························-~---····· Grading Permit Required Yes ( ) No ( ..,(--------------------------------------------
Rear Yard Set Back ...... /.{,. ___ : ....................... · ....... ~--······-Sewer Disposal Plant Capital Cont. Fee .......... si'.'A. ... ~ ............................. .
/ tJ I L..--Distance Between Bldg •........................ Sewer Pumping Station Capital Cont, Fee .... /¢. ... ~-----~-~---·································
Off Street Parking Spaces ........ ( ...... 7 ....................................... .
Sewage D;sposal System ------------~'tr-----------------------------
Zone -Residential ( /} ........................................................... .
Sewer Main Line Cost .................................................................................................... .
Sewer lateral Connection Charge ·····················-···--·· ................................................. .
Water Stocked Lands Charge ....................................................................................... .
Zone -Commercial ) ----------------------------------------------------------Water Main Pipe Line Fee ........................................................................................... .
Variance Water House Service Charge ......................................................................................... .
Eng. Check By --------------------------------------------------------------------------------~o~ Water Meter Charge ....................................................................................................... .
Sub Total ________________ / 9CJ ---~ ----------------------------------------
::::o::;r::e~--~::s.,::::::::m:~::::::::::l:i:he;:r~:• F~~ : ::~;;::::~~:::::::::::::::::::::::::: ::::::::::::::::::::::::::::
Date ------------¥ ~~_Q ___ ~ 6 __ z___ -----------------------------------------Total Charges ----------~--¥._(. ____ ~--~--------------------------------·----------