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CHEDULE ���- ' Permit No.
_DC..
6'r2 • CITY OF •A PARK HEIGHTS Plan No.
�S
:URCHARGE (For Dept. use only)
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=ERMIT Si 7
-I LITY
A PLBG. APPLICATION FOR PERMIT
Q.A.C. �/
CONNECTION Date 7 T/7
19 j
AMOUNT DUE
STRUCTURE USED AS
REFRG . HAN<
BUILD PLUMB. HEAT INSTALL ALTER REPAIR REROOF RESIDE MOVE WRECK SI G (-
ems.
Address
=t Address
Contractor J .I4_& -yam✓ Address
- - or Reg. No.
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STREET SIDE BETWEEN WHAT CROSS STREETS
-/ s`
BLOCK ADDITION OR TRACT
WIDTH DEPTH SIDE LOT CLEARANCE FRONT BUILDING LINE
WIDTH LENGTH HEIGHT NO. OF STORIES TYPE OF CONSTRUCTION ESTIMATED VALUE _
❑ YES DETAILS OR REMARKS:
❑ NO
Jlgned hereby makes application for a permit to do Building Work as herein specified, agreeing to do al or ' trict . c• • ce with
zes of the City of Oak Park Heights. Contractors must register with the village before permit can be i ed.
OWNER /CONTRACTOR SIGNED ,_./LLB
OK'D BY