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HomeMy WebLinkAbout1992 Permits TOWN OF YELM BUILDING PERMIT Building Department Phone: 458-3244 B kW€?rlr.. Ct3?kSt b£ 5#a3TP.od wtffiin 1.20 fSel~`4~ Date- Site Address ~ Use of Stnsctur~ Owner -Address , _ - Phone C07-ItZaCEOP. Addre,sFhone Subdivision L< 31c3rk Short Plat No. Assessor's PareQl No, Size (11 ff is an unpiatted lot of ;'ecorG, was it created prior to duly 29, 1974-, Yes F! No 11 jAlkai e'.'isting structures, are lCiCat£, C~t cm th'p~ Plot Plan scrF(}rEoa~ kXo Item ~ rife for Fee Fee Hlmv,z Mosir,g Mi*imurn'dista'nce of structure fron-z properlS~ lint"': ! NOTE. A![ Local Sale t o ateF.# I 4:1is Fl i 3tit ~4;1t~Jtf€c# #;G~ eci~f< 1 %i; F RON'T DE Sl7F_ REAR tt.:f of Road ~9 e Use ?or?E j Type ns . # t`Ce .t~[}~n J [ ~ aE~~ t f~ .~fh ( tea. a teas SINK" APPL.IC:ANT'S AFFIDAVIT Cv_x u4tj fl hat ( hL2vo-_ ;rad „ t d ..Y.~iTR51d-' t'1't i~lf~Yltl l.:f;€~ C~STIt"4tt10 i4~S2t1i4t Et?F= ~c ieiY:>i[{C-'~ c~Sl ^3 i.~: the Jd§n< to, k trt,E. Cori Li.+'<.'=K^t. t tX"1 C~Y;4{~y aldi ti.c propOsed Strt Ctrl is srr cornfGrmit}l with of appt.a. is T,.,wri of Vcb-41 E ~t,l. tea inn 'ing thu- q vernii bf id subdEeision' and in ,addit cn, all co> er..an;s. easements ")nd xLstricai,ans of re,. ord €f ajptui a~- a , owra"Wr, i turfEt t C. "'tif, tzai (f.n_ a cufv. ttly rep,_tf r ti r:oz trac`~~r in t.1 ~ Mate of L~hsn~a3u.r~ e AppficanCs .Sjgiaature Him 4- 2 >>ate applicant rawest call for inspections listed bealou, Foot rq3 Ms}-a ion j (prior to P:'ourfng to cove'rfntj~ 3 Final ~ _ e t OFFICIAL USE ONLY . p^rnzit nacussat ` s Is the pros ett vo- . SEPA' Y,?_, TOWN OF YELM BUILDING PERMIT Building Department Phone: 458-3244 - Cl' C>4~f FCY :.v'L n Cc X-, Site ?e?ress of Sftus#ure i Owner Phone- Cc trrtctor _ _Address _Phone__ _ Su sdtvisior Fr Short Flat No'. r ssessor s Parcel No.~. " ; ° Size if an unplaft(?a lot of record, was it created prior to cuiv'N. 1"974-,' Yes F) N,,-) (A What ex?sting structures are located on the i Plot Plan 1 ~ rs`i rr of 1 P erm Basis for Fe ~ Fee , i i 1 IJS~i '1 1?+ j 4 Ctai [ tE Nan Che Virnin iym cttstai)CC' of strrcCtUffe f,0111 #-arvPertu bise5. r Fjr'TE. "11 E " i `.sirs ~,x er,i rated h ' ,Ea ? +~iec? i eiO?l? use Zone F~; ' Corns. Occupancy w,?,rov al IVo. Pe rv i-, APPLICANrS AFFIDAVIT i cert#fy that i have ruac,, afro exai)~ir)Cu the inlorrna ,psi r_ ,nr,R;li t~ wrtiiir, tlr= a,.t?IE N; n ano i; . w the a;nf> ;o N Pr tF and correct i al:-o c .r iv ina. ,r,E pn7j3osed strudure ss in co,torrnftv kvith :iil applical%le Tc ua, of VC.,bn re ~iila .or s inch .'r ,y tflose. 3OVCWOg 70118 arse land s,rndlvisli r., ai,(, in adcit=.o= . a) -oGanaris. ea5emenis an t s sixict#cros Of rCr rd. if opplyinq as a o.>47oCtuY: # s p~hPr .z9;tk.- ti as i gym Z ~~3 trtiriit Yogisieze t cc~,~izaclo= in the Sia,e of V= shim ccni. ~gapiicants 5igr1<trare Fiem °zf'< Applicant merit call € nr dIlwllti. listed F. elov: Ft~cu=n~.% insf?ection _ pr?or to t30t]rfi"1~} } (j?TJOr tEl Cta~PFS67t3i Dcywai. Na[':i;,g Inspection t I OFFICIAL USE ONLY S . Permit necessary? Yes J i_i [hc nr: ,e t exry. wt ;r"r, : ? ` ; F. 1d1 a n pament one: 458¢3244 (Work mist be started wit-tin 120 clays- fate ~ - Site Address€ Strum <E- : , Owner SS Contractor _ Address _PI of e Subdivision I_(,t Bbdc Assessor's Parcel No. i4 an =znplatked lot of record, was it created trios to .~iit~ 2~3~`tC) °3c C1 ,:,a~'hi~ R~ ~R, at _.,(istrrg 9Ayu ?ui-es am.: ioca:e ov, the s»=a~eiky?. _ Plot Plan .F eScE i~tin,~ of t x _ Item ~ Basis for Fee ~ Fee I3,.It!dit;c~ i°te,eia j E T F,. Minimum distance of StSuctur'e fron-, proper1v t)i E:. %11 E r)C i 4ii.-y Tax gyfwr,3Tt,this Pr,);(.c:.t S I h lull 1-w A ocklt 3407 i of Roa.( - - No --l-ermoi Use Oi)c`' } I.~7p Cons- ? OCCupan"L` APPLICANrS AFFIDAVIT I certify shat i have read and ~xa lined the iv&-)l ta;ion ecofadn?(i within H)i, ; np4.a et ,nd kt,,c i?,c ~ , be trs,r a.t,o cErii`y th; the proposed structure: is in conform tv «tlh aii a~ ~ E a~at To :n of Yd m Ea:grEiatic rs MCIU iE)g rh> _ O-), el,nin;j 7omz g and on:~ subdivision, and iii add i € . ,.3: _ veti r ;s, easements aiid~tc>s rict,oris of record If applving as a con?rac#i r. fur2zet cerfii: ffiiat I 'm a eurr(E tik R g1St+ Wkj cr.),T~a Y M the' 'Stag" ' ,4ppEicarss_s St~n~tcEt-F~ yrn fYrat~ j Applicaut must call Ior inspectiims 5sted below . ~ . III I=~o;tt~~ inspection S (prior to pouring" f gaming Inspection C riC~" io covi2 "iing) E s. Drywall Nfa4ing Pnal OFFICIAL U-SE ONLY hjre!;)w P.nru t :sae if s r;:n pro;eCf zxemrt from SF.PA? Yk? ! No TOWN I. BUILDING PERMIT Building Department Phone: 458-324 !Kook must be started writhin 120 davsb- Daze „ Site. Address €1s of StTr~cttare C)wrs r--_" - Address ~h (otiractor ~Addr~ ss~_Pltnr~Q Subdivisiorx _ Lot .rt Flat No As ess©i s Parcel ^€o. -Lot Si 'f an unplatied lot of record. was it created prior to July 29, I W4? Yes Ibrr !w1 k"hat existing structures are located on the Properf?i1 Plot Flan I? ,r E of wur9s I an€ a Brits for Fee ( Fee R e v -a~ Fee. Minjfn fr6 distance of strucwre ftom prop--, ov Iitaes_ j dt~TL All C~ pax s~eneratsd -this (ro;ect I FRONT SIDE S!EDE NEAR to of Road i'jse Lome Type Const, Occupancc: Hc3101 Dept. racc~~s 1 :rtiC-r;c~t'4c~. Cennl* APPLICANT'S AFFIDAVIT I certifv that I have read and examined th ;nforr} a ~oRa cc,olained '--rthm file py-4icat osl be true arad ortc.. prnposed structure is in r n#ormits- with all appitcaisi„, Town of Yae4m regR3iations is}z iar-ih~g ihvsc if?„ ::.r€'ivi'ions amd _n Co:,_.za„ s. eas2meznts,anc restr t ray qJ1 reword, if anptymq as a romrwi +r. I iuviwr r~=3~ti1R, !hat i m, a regislere"I contr.ami m the i tatc. ,lhinoton. w_ Applicant's S'gilatur(' Finn 3 Applicant must call for inspections listed below ! Font ng Inspection! i (prior to t 0mirigi I tLri d' it:mil ??rvwa€'s Nailing fnspectio:l Shore;ine Perrn;t Asa:~;'? I`es t 1 -l s the pn))ect exempt fro-n SEPA_ No 77 TOWN OF YELM BUILDING PERMIT Building Department Phone: 458®324' (W(:)rk must Lie started Within 1,",20 d, W Date Site Address- Use of stTuct 1rc address, Photae_.._._..___ Owner Cortracfiv _ Adur~s Phone ubdiU'3sioty - f° Lot Nock cr Short PI<at ?'o_ Lot Assessor's Parcel o. r x .t. Lotsiz ,,f it. c., 7, recl._.........,._..._ If an unpiatted lot of record, was it created prior °:o Jui 23_ 19 V -,F, ;a T"'o 0 Sectloe, _"1 7eutsship~ ®~a tg~ What existirsg structures are located oti the prc SErt~,? _ ' S r`~'tal~ Plan ~ iptinn of ~r~o k 1 Item Basis toy Fee ~ Fee 13ttt;E,inq t i' 1 e itis,ltif F„•I. ~ ~ Ts~tl Ft?ti Mlnivnn, distance of structure irorii property f'OTF t~Ef 6- 5cal gale, ,Tax 2eoerate i E't,, this @~t~~ ect ~'tliufd ;1~ <t-sett 340 ._.T pc)ad Use, Lorne 1 Type, C onst. I `a11JiE 3C'lF y..t::. rppyoval No APPLICANT'S AFFIDAVIT 'rick, that 3 have read and exarnined f!-te 3n rmatioEl con(ailw i ti Frhi e> and Ear,-,t, alk! x ?e to `)e ftu, r?~ o:: E~r,pCaSec~ striE~7raE'e in ronterrni8.y with all app ahlc ! opt,; of `r`ei=.n ree;tslativis ia?chxJ~rg tf"~~~t ~~ricrers 3 ,cr.Fe?~ airet € ncl teh.;3ivi5irJl'2, a;ld u. addrfio,., a,. ,,ev. a7s. ea>emva?ts and restricjiop~ of record If applOng as a c,?nt.a tom?, ° °urtSE cry U¢v !hat I a currently reyi_6c E_; ;.?€,Prae± r w Sale Sta'? t't as€;?;m r , .,r (applicant s Signature Firm f& ?Date Applicant must call for inspections listed below l Footing Irtspection €prior to pouring) I Fraiming Inspection P c~ri~r uo co verin~) OFFICIAL UISE ONLY ~^t'.:~ir*;ili? Permit neces5arv? Y?s 71 No F, t: the pfo!eCt ex+., ~r{:ili tiC`'.`i ? inc. ,Y~i TOWS F YELM BUILDING PERMIT Building Department one: 458-3244 E,kiilame,. must be etrZ.?'}?f ;z+si=_f'itttI2t`? ca3ys1 Date _ Site Addres _,c of Structure t wrrez A ddrFs.s ~ Phone Contractor Addres Phone ' Subdivision Lot ~Nock or Shoe, Plat No Assessor's Parcel No.. If an unplatted lot of record. was it created Prior to Ady 2 19 4,, Yes 17l No 1-1 What eksting stru tore ~ %_acated osr the pr0l)y' Plot Plan T 1)~7's rirglrm C( ucr= - Ikeax Basis for Fee ~ Fee a ;t1g 11 44 ~ f _ ' 1.39 Check, vv f inirn~urn diMance of structuye, Iron) pic,pertE' t]t. ; ~ ~ X21 i CSR, ! "2cEix2~ T ,~gE^i?D 3er r? 1>~,~ }f173 $~ir.je C't shouid he c_ . e W0 to of Road 0'se zar,L, Tk.;re anst. tlcCrsl?3na, r . ~ i (-~afti~ C E t_ cckss APPLICANT'S AFFIDAVIT certify that I have read and exanll rrcd th'< ritvrcrZar ,a~ cis Sin ~ ~ttfE;d the + pli at=: ,~r a~, I-~t tre ~a .e ss'~F '.«v r id cocre_ . (a~;, Qc,Ci#v :fie ;proposed stm"C t!"e is in conform iN, with al€ applicably Tnwf)')f Veirn r~"qulailor'* 'sncluijinl,~ tha E- sov,>rnir ~ zonino and tarin _Jhr,r is?os^,. av'wd in addiu'c 1, A (70Ve(fa1^,'ti9 eaw_ffients arid. z5ff ttr~tt5 < f recrird_ a~>p3lv's;,g a~; cootiactoi. i iarthe c,~rlifv th~v I am a currjwlI, re rsCOntr3c<<>r a~ i thin Stare of Rafe applieaw's ~:Sgnartrr~> ; 5 ~ F, mi i a e Applicant Must call fol inspections listed below. ion*,r~ inspec#ion tpr7or i0 Pouring ! Final OFFICIAL USE CtNt_4' Shorelile rer,nit er_ 5.ar Ve.s N, Is the pr t ext111,0ri <rI l eJ U TT OWN OF YELM BUILDING PERMIT Blding Department u1 FpBhone: 5®3244 tWoyk mi0 be started withi^ 120 da1Fsl D aw Site Address Use of Structul'a - :x her . -Addrtis5 Phone C'or;tractor~ F l.i t'}diV;B€OTS _.c~I,'~t~[. ti3" "J'Fi"i Fri Assessors Parcel Ne-, Lot if ail ujiplatted lot of record. was st created prioe to July 2'`). 1974,' Yes i= 1 No 1-1 Sae pti hat r"3.TV_ 4xatecl On the R Plot J-'ian ~ J e(~si:r;ption of Wo [tern ~ Basis fear Fee ~ Fee BI,iIa€tECz 3 - ps~F~itt>~ FiL' 1 (F ~ tE I, >a P~Pflr; Checked b", mirliiilitl'a`t distanc: Of structure (ro ill S kf - T,=~x generated Il TH f Tli''t r >l,atrlcx~e ~txiEt` 43 t' E FRC) N NT SIDE SIDE REM, TO of Road d. 5e Zone j Ti pe const. C)s ciri ell c: ,.,.y Heah. Dr Tt : cces i rer?i;y tf at I hav r= d and eXami:ied the inf.`matic'n ontai said v:ithtn thc, q)!) at.1 ?.zel,a ttjq _a„Fe_ to n~ t€ z th t fre mv,po~,ed sEruct M €5 s:1 ct~rtfran,-,iiq +_kith alt applicable TovFjj c>' Velin tegFitU[F i=,rl; ping g,vei!€ ~i;~ zt~rr.' y : r d ar.~' ~t3h FVisi a. andi< a 1u:Aiz„E, all xa~~~e.lar,t5. " 11 t aserrientS and i'~zh 04-1135 of ;er1Ji(;, if ~'.l)r;y i~c7 at, N c.rl it5!'dct?i, I iur her riE f v °it~ E l am cu,-r 7,Flv lt. ttw, of ~g7pl€C~ tI5 {;f~Cn i1r;-. Firm t>p?p ik-ant Mimi call far inspyeciaans 11sted below iprior to pouring) i Framing Inspection 1 D S'kk,all tva;flog Inspeclion Final OFFICIAL USE ONLY I owline Yermt r~ essaa,~ i 7 t P t4he rolect exe.i.p; f nr FPA? yes N:, TOWN OF YELM BUILDING PERMIT Building Department Phone: 458-3244 l' ovk mu`, be stavtid w,sthin 120 i2~V~t Date St"'? Address Owner Contractor Address_ Phone Subdivision Short Plat No, . Lot- - Assessor's Parcel If an unpiatted Int of record, was it created prier to Jilty 2,0, Y~,s [-'I No What exist'inq structures are located or) the P of Plan of ~Vnrk Item Basis for Fee S Fee i t'Cr Lts' M4Vi1 3 A t ks4iwd f E r ' I Plan Cli~cre,i - _ Minin,,U n distance of strri: lure !rain piopevi ?ISLES,: ~ j NOTE: AH SA es a ~e:lit s._r ::i! hl f is ~ t tfeCp to of Road Llse Lone ~t' p Cons,, fl ~~rtsi~< ro~c~ _ r ~°ali~ that t. ~ re~~ APPLICANT'S AFFIDAVIT ! ~e:ri4~= t a> a have r <td ,rut exarnmed 9ne .njoenl a.ct. coalt~~in i ct~i?litr', tt)z j-)plicoljor, aid 1•a.otiv £h< Balm to i,~ Ira.te ai~~l .orrec: 1 also cen;fv that tttf j?Soposed stFt3c ir2 ,siii all aipplicabje. Towo of j'elm 7C: t~~~iit<.175.: ft <<iL 1L7 ;~2f7Eq 5?~c^.17x ,lc~ g and larlCt 4u3~ siViSit]!l, rwd iF] ~d~7t[Z7t~ f_ies; rianfS. +2 2s,2cne is a..16 s st ico ns n; ;PCGrd if apnlviing as a conSractc,3, 4 iiirttr, c-Cnilv £'brs 1 orn a (un rite.- rc,~i trz cootracter in the st.-,_ ct Xa a mgton Appiic, nt Stature Rrni Da e - Applicant must call for inspections listed below 1 Fnc nn4 )nspection 'pr or to pouring) R annng _inspection ;~~tar roe=.~rt!-ig! i r' t ua?[ Nailir ~ ins eehun p OFFICIAL USF ONLY Tom `-f_. A% T TOWN O YELM BUILDING PERMIT g r~ I l i eaDepartment Phone. 458-3244 (Work rr3trst be stattzd =lthin 120 paces) Site Address. L?se ©t ~tr!settsr~ 'hone Owner C«ttraCl©a_ Address. Phone Nock , - I;hort Flat No. ~ ~Lo Subdivision Assessor's Parcel No. Lot Size E;q r< If an unpalatted lot of record, was it created prior t+_? Juk, 29, 197744? V'?, Uf No 0 5e'Ci1Or,~ ~ ,Lt 1~l I? : et.w y~"' 3t existi,t strisctmes are (©cate(i <n the } s- art s - -a- - - _ i i- Mar ~~t~Fl~rt of wo& Item I Basis for Fee ! Fee 5~ F - - - 4 ~ I Tutai -v - 3 s r ~ mh-)A lum distance of structure from prop-erw NOTE: All LocJI! Saies Tav 3,~ieh~ r his f z :~a:et rr`I b« ears'1ocz .340i" 'shu ` FRONT SUE 1l IF E,,% R TO of Road i igs?. ZotleTti l3E £.oi14_t. { !C_Ltilraslctl I #Gat51l Der)!, AC-";F- - 4 ?4u 1~ppro.+a! l APPLICANT'S AFFIDAVIT 3, t_ertifu that I have reaci and exarnincd 0112 inf+~r~`,i&ilOst ~:otataiii d s0 zin ;,ie iafinn :.zild Wow thc san, c +..o L~e true a.ld come. ,rl tf;a proposed struclure is in, Conformity un!h ali apisi:cal l= T«.t n of 'e 3 ?tjlnt3vlrs inc it ;i:t tho gov(?n rg _ aping In hnd subjsvis;on, and in od( ii on, a?i co`'21.3r,t a_on2vrts and restriciitolas x record. if apnlcF « a:iaza,: j ~.a,h , czqif. h,-,~t :.gym a ex:rro i1? ra;, to d contr,cor its the State of b ashiri:~Ecl~- Apphcant Siena°ure Firm} ?ate Applicant n-.cast call Ior inspections listed WOW ?;oboe to ponrinq t l t~insi OFFICIAL USE ONLY Shorehm Permit neeeS-dr, . " e Y.. `n t: U::3 SFPX V _ No TOWN OF YELM BUILDING PERMIT Building Department Phone- 458-3244 (Work must be staried v"thin 120 d iv5) Date Site kr3cfress ~ 0,$C Of Sh-LICtUre- j Qvtner,:° l 4'cddress Subdivision- Bklck or Short Plat No, - Lot r Nn. L t size 11a5essrxr"sParcel H an unplaited lot of rec-ord, kvas it created prior io Jul,) 29, 1974' Yeas F N ~ !.1 wErnr7_ fou+rsfap_~~ a.zgc that existing structures are kocated T, the C?t'oE3k--2't~; Plot Rasl t 3! G!.rt=.3ttos' of :Mark €e t Basis for Frye Fee 6 i t t _ f _ i - Min~munl distance of 5ir_ :e}:e i.,+rr rtispert hoes ~ siJUTE. ,CIE E ~r. l (ti Tzx generated tits FF0, r .€,r,ll E.1 EaE c,,d; -d '407 tL> i7f IGnE Ge ~!~ne 1 T!.f}~e ~~+~rsst (ccis(~aFi!.y f ~F a:e; _ H- :aEeh Dep< :x>s APPLICANT'S AFFIDAVIT 1 that 1 have tea a d exanain~,l the 3nton'ai._a r it3liti 9h2 ppfit_aii..r+ ;:'d k, nin> to (,e true - t ,rrve t ts:7. -rSitu that Aii<; p: ~t _ ,;Od strucfure is in csnifcraity" with 111 applicable f o,~;~3 s[ ~'elrr~ x€guC~t7~~~ t~~lti c,rz~~ €t~g e ~c4~tn ng c ~it?y ~t~~ ~i~,~ ~€Ybe;ivt~x n" a~~c r ~.~t.~ ~n_ all cove ~arles_ yetr• its and Yestr d3 t> f. coed if 3p as a co.'tractcar, ? ;urther enttitL i'!aE 8 an, :~.ed Cow, ~ac;~r ti f ,a ~~€at~ ;;r ~1as Ens=c?n. , 'Applican't's sjgnpi.-,ture .f' Date Applicant must calf fm inspections tiste d below j (Prior to potuinq) Framing Inspecli"on OFFICIAL I ISF ONLY :,relit e F ermik rrcc a arv? Final ,,No r? I c ;;rc n,.. '..a SE PA? es No rne: OF YELM BUILDING PERMIT apemen 3244 B 458-~worh- Must be Stalled k0thin 19-0 lay5) Site Address, ~ Use o' siruct€.re Contractore - - Address_ Subdivision - Lit ---Block ~ - E>s~ ~~cart Nztt N,-), ~ Lo,, Assessors Parcel if an unpiattfed lot of record, was it cre,~ted priov to juk s 1-1 , V+ hai exis1mg structuycs art }towed n=T+ thi g) ol 10" Plot Plan Item ~ Basis for Fee Fee ~ililCiPtk, ~ ~ E _ ~t+ t~7et ~tct€,~~ i'+ft€ni(Pluny di..tance of z5iruclure ftn ll i-t'D'poE o iiflot" NOT iAl! Local 4+ (e 5 gene 'Vod ..~t. Mis PF'Cmrect E'€E U'4e zcil3o Tupc E._'Cnnq^ (-ji-( i.ianctJ 3 °"tzY r)j a=gad € o-'-P''l APPLWAINT'S AFFIDAVIT I ceyk - that tea rzad a='d exe.vmngd (11- t~+ sr t±c+~ ccrkll"Iuvi d tiri Nf) rh=] at.? 1a a+tt>n and know a_le car t'-' {,+._'rue "nd r.ecr i ~.so ~-O.tfy Thai the r ,n sed str~~c ~ s (n confor" nity wz1 h aR a1)plicatxe£oav€ . `~'e!m rzaulafiora~ rn ;rid r t~i.?s c~V"rnill~ zolIin~ and bil Id ~ €6d ivision, end in od Jar ns~. , . cove iia€ i c._,t~ttact+~r, I P€.?.fJle~t + . i'liiy that E aol . arr~~nd~ t ,~t~t;_tc , at7€ractoi in H S tite cif ~'Vas~ingto€1 e s mews and rFS+, irtians of o- i. if t f : i os' : ' ~Sg~~ilCc'1e5t'3 ~I~iZaTi;fE' p" ze 1AFIez3 71-7 i Applicant must caH for Inspections Hsted below ~ ~ ~ Inspection ivamSPg hSi3qCt1C3il c cx4) 3 `rraai 7B=1ding L BUILDING PERMIT e artme 458-3244 €',''t+,.y3" L must be siarted k0t~;n 120 day,,,) Da Site Addte s _tr of Structure r t rCSS .Yho:ie Owner s3`- _ Lot S' or" Plat No Subdivision Assessos Par<_e= a. -Lot S,ae tf an unplatted loi cf record, was it created prior to 4uJi/ 19'/4' Y,>K 0 N=~ ! I WhM ehistirt'q °atrt o.ne~. acre ioc2ted on the l}tole is;?_ - lit Flail PetiCtihtior> r>t" 5vtt - - g ' Item Basis for Fee ~ fee 1 .~SE3~C? hy~ I E omi F v.- Plan Ch,-rkedl i!<tmttx distance of struakire ire-)m pt'opOty life-': t FT 1-f F: -All -,Os i'e~x FRONT SIDE STC>v REAR t c4 Read . l Use zJY1' 5`9^`..._,.....,.~-....._.__eE {7diEt SJ TM Y HldIf h ~~1-m f~i`cS'css A.PPLICA.NrS AFFIDAVIT "-'zNy6a read ai,d er:am'st ed the 4ntatz anon C'mtaw"a wM14-1 tl~ app c.;tkm akl ± ~ twh 1 Erb;: <w ine ;F, iJv u= 3n'q c~ w ..rt. I ..is: ce ~ t`w the p>s'7~powd eW Un? isit? c nF tr;~it with all eiap lica~te T,i~wa cat Yetm a _ tat tv~Ee z aGidiu; E ~ z <a,reri~in, ~anin! .=3rt~ tn.rna and it, n -fiH on" E?E, cCzvenan= s. easecnerkfs and ra_sftirtions of 'cord' lE avv l,imq a5 a ccsrtirfrtrar_ ( fut-Iher ~ _,r't , ri ; ? 1 aa2 a r_€iTrIWJ= 1 Ef ~,isterc -esxtra~-fcr in the Stete .'a~~i~7gtot~- t~r~pliearat`S ;ilc~naEU"2 Date applicant most call for tnspea-tt on"s listed below % fp~Y1tJY to otts;4ly} (nSpectioQ OFFICIAL USE ONLY 4 ..tei;r Permit r-:e prow ..G « rt frci-n SPfp Yes No