HomeMy WebLinkAboutPL 1983-2110 Sewer & Water Connection FEE SCHEDULE Permit No. - /`
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_DG;. CITY OF OAK PARK HEIGHTS Plan No.
(For Dept. use only)
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_11. PLBG. �� -cy - APPLICATION FOR PERMIT
CONNECTION v �CI v /1 ��, 1 Date 19(k"
AMOUNT DUE CF : ;� / �-' ( ` 16 . C/L� r Lf/C /� //
RUCTURE USE
REFRG HAN
BUILD PLUMB. HEAT INSTALL ALTER REPAIR REROOF RESIDE MOVE WRECK SIGN
_ U C
a d./'e c, .i_, eti Address 7396/ /�/ . 7‘-. -('
Address
Contractor (-ter 5<
,.-/ LX_ Address 6 r //1- -ems
-or Reg. No.
STREET SIDE BETWEEN WHAT CROSS STREETS
1 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
=Toned hereby makes application for a permit to do Building Work as herein specified, agreeing to do all work in strict accordance with
:es of the City of Oak Park Heights. Contractors must register with the village before perrrlitcan be issu
OWNER /CONTRACTOR SIGNED 4.
OK'D BY