HomeMy WebLinkAboutOT 198x-222x Cement Patio Replacement FEE SCHEDULE �/ , Permit No. /
CITY OF OA ••RKHEIGHTS Plan No.
_OG. / 7 SD 439 -4439 (For Dept. use only)
:URCHARGE
-IECK
— ILITY
:AL PLBG. APPLICATION FOR PERMIT
3.A.C. �j
CONNECTION Date S� a
19_
•
AMOUNT DUE /8.00
STRUCTURE USED AS
REFRG HAN
BUILD PLUMB. HEAT INSTALL 7 ALTER REPAIR REROOF RESIDE MOVE WRECK SI
R \`L1 (1 i l Address 1y Lo"A r SS
Address
Contractor Address
-Tor Reg. No.
STREET SIDE BETWEEN WHAT CROSS STREETS
BLOCK ADDITION OR TRACT
WIDTH DEPTH SIDE LOT CLEARANCE FRONT BUILDING LINE
WIDTH LENGTH HEIGHT NO OF STORIES TYPE OF CONSTRUCTION ESTIMATED VALUE
O YES DETAILS OR REMA (� j
❑ NO L.pd -1N ( Q.reMQ!\i C , 110 Vs; 1
Jlgned hereby makes application for a permit to do Building Work as herein specified, agreeing to do all work in strict accordance with
zes of the City of Oak Park Heights. Contractors must register with the village before permi c- • be issued.
OWNER /CONTRACTOR SIGNED ,\ .. '__. 2 0. A`;
OK'D BY _