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FEE SCHEDULE Permit No. ,o 4 /70
17 0 CITY OF OAK PARK HEIGHTS Plan No.
CITY BLDG. 439 4439 (For Dept. one only)
STATE SURCHARGE
PLAN CHECK
CITY UTILITY
EXTERNAL PLBG. APPLICATION FOR PERMIT
METRO S.A.C. n `� `y' (r��
UTILITY CONNECTION a ' " (!/, Date __ 9 o?'
TOTAL AMOUNT DUE / 7• S 0 STRUCTURE USED AS
REFRG HANG
...
MARK BUILD PLUMB. HEAT INSTALL I LT ALTER REPAIR REROOF RESIDE MOVE WRECK SIGN
SQUARES I` I -I `� /�( ^I I ^I jl ^ I C
Owner ` t'e r�oT Address `1G / O^-`°' c,- /it/
Architect Address
General Contractor °O Address C
Contractor Reg. No.
NUMBER STREET SIDE BETWEEN WHAT CROSS STREETS
LOT BLOCK ADDITION OR TRACT
WIDTH DEPTH SIDE LOT CLEARANCE FRONT BUILDING LINE
LOT
WIDTH LENGTH HEIGHT NO OFSTORIES TYPE OF CONSTRUCTION ESTIMATED VALUE
STRUCTURE
BASEMENT ❑ YES DETAILS OR REMARKS:
7
❑ NO
The undersigned hereby makes application for a permit to do Building Work as herein specified, agreeing to do all work in strict accordance with
all ordinances of the City of Oak Park Heights. Contractors must register with the village before permi .e .
OWNER /CONTRACTOR SIGNED + ��
OK'D BY
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