HomeMy WebLinkAboutPL 1973-599 New Single Family FEE SCHEDULE Permit No.
VILLAGE BLDG. VILLAGE OF OAK PARK HEIGHTS Plan No.
STATE SURCHARGE
(For Dept. use only)
BLDG. PERMIT
VILLAGE UTILITY
EXTERNAL PLBG. APPLICATION FOR PERMIT
METRO S.A.C. �
UTILITY CONNECTION Date 19
TOTAL AMOUNT DUE
STRUCTURE USED AS
REFRG. HANG
MARK BUILD PLUME. HEAT INSTALL ALTER REPAIR REROOF RESIDE MOVE WRECK SIGN
SQUARES — J r
BY X
Owner ( 920-(..A.trk'a. Address /. � (0.- -taN �Ll -z- " )
Architect Address
Air
Gerrerat Contractor . _ ' Address ' ' l •
Contractor Reg. No. ' � .l�L� Q
NUMBER STREET SIDE BETWEEN WHAT CROSS STREETS
i s — L -- eav- �.
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
0 YES DETAILS OR REMARKS:
❑ NO
Th. dersigned hereby makes application for a permit to do Building Work as herein specified, agreeing to do all work in strict accordance with
, antes of the Village of Oak Pork Heights. Contractors must register with the village before permit can be issued.
OWNER /CONTRACTOR SIGNED
OK'D BY '