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���7.'y�,O/%'�' %� � '�"r/s h -. y� t. i sy''',—` •r q I <br /> <' !/ ;:nice/ E+ 9 b., A ASV a <br /> /„..fi/.....„ ,...„. i•��.cu••:� 2 2� \u,.....wFa..a..w.....a<..,.«.,J>..�...A'� <br /> SITE ADDRESS: 23 0 g 11 ASSESSOR NO.: 54 3 71 <br /> LOT: BLOCK: DIV: ADDFHON: <br /> �.. <br /> ;was : , ... 7:10 .,>.• 7,.r'� w l •^ a '^ . :zJ.h,,» . <br /> e: Name: Name:ts <br /> thiom <br /> Mai in Add s: t Mailing Address: Mailing£ddressI. <br /> 931 g Men Lie. SP *0 4456- Ed <br /> City: State Zio:K! s i <br /> City: State: Zip; / City Stat/e,� Zi <br /> E e✓ pre& e u✓(,dam i7 IDA �8�33 <br /> Phone No.: Phone No.. Phone No.: sop 'fS? O'133 <br /> Contractor License:Et,S t7SKE <br /> Contact Person: Phone Na.: <br /> f ^^ .: ..\\v\[n.�J\�`'�•b Zi\Zq\.e\ • : : ' A•.: • dv�. .' ...:.v.„ n :;i:. f < �Y `4 lQbi5 <br /> (Check One) <br /> Single Family:, Multi-Family: Apartment: Condominium: Senior Housing:_ <br /> Retail: Office: Restaurant: Manufacturing: Storage: Bank: <br /> Assembly: Accessory: Automotive Repair: Other(Specify): <br /> D RIBE OF WORK: e Otte✓ ail stt he /7iIX7etx➢G Li-N‘ I 47 (d C Qt, d�tl /BU �� <br /> _ p� ay <br /> is » Q 3S <br /> Street Setback: ft. 2nd Floor: sf. (Circle Y or N) <br /> 1st Side Setback: ft. 3rd Floor: sf. <br /> 2nd Side Setback: ft. Basement: sf. Shoreline/Wetlands Y N <br /> Rear Setback: ft. Occ. Group: Water on/Adj. to Property Y N <br /> Use Zone: Carport Area: sf Soils Report Y N <br /> Type of Construction: Garage Area: sf. Sensitive Area Y N <br /> Lot Area: sf. No. of Stories: sf. Latecomers Agreement Y N <br /> No. of Dwellings: Building Height: sf. Fire Hydrant (250 FT) Y N <br /> Lot Coverage: Deck Area: sf Variance Y N <br /> 1st Floor: sf. I q Covenant <br /> Project Valuation (Labor and Material Cost): 1, &o.®D <br /> THIS APPLICATION IS RECEIVED BY THE BUILDING OFFICIAL UNDER THE PROVISIONS OF THE UNIFORM BUILDING CODE. AND SHALL EXPIRE <br /> BY LIMITATION AND BECOME NULL AND VOID IF PERMIT IS NOT OBTAINED WITHIN 180 DAYS OF Tills APPLICATION. BY AFFIXING MY <br /> SIGNATURE I BY CERTIFY THAT I AM THE LEGAL OWNER OF THE PROPERTY FOR WHICH THIS APPLICATION IS ISSUED OR AN• <br /> AUTHORIZED GE THE OWNER. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED <br /> WITH WHETHER SP CIFI HEREIN 0 .INCLUDING CALLS FOR INSPECTIONS. / <br /> SIGNATURE. ® DATE: -2-0 r <br />