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Permit ^ N� PLAN CHECK APPLICATION PLAN CHECK # /�) —6.2 U �� ----' �� COMMUNITY DEVELOPMENT =EP~~"""�"~^� ~ ----— ^�| . # �@� �� ^~ �� y- mmmwSW�Mmm� pn�B�m3umv�Omm,mmxoon7o� (m� )o��*�i _ DATE ISSUED _-__- /0 ADDRESS: /�/�� /� /�� TAX MAP/LOT LOT: LAND USE: - ___-- °="".^"." NAME : % 0oDK/SS: LHSl� REISSUE: FLOOD PLAIN/ SENSITIVE LAND PHONE: ____ _-- ------ APPROVALS REQUIRED CONTRACTOR � / PLANNING: __ _______� ENCIN[E8IN�� _� �� oU0K[�S� ��r�«�� _______ FIRE DEPT ~7- s< � ` � OTHER: � —'--�---------- / '------- PHONE: ��'/- ITEMS REQUIRED LIST/SUBCONTRACTORS: ARCH/ENGINEER ,- / '--- BUS TAX: y,v^/ c 74' CALCULATIONS: p - Wye./ TRUSS DETAILS: --- /' _ C25 4 c�� /�\^�'• _ PARKING PLAN: LANDSCAPE PLAN PHONE ��YYS �____ • OTHER: COMMENTS: - ------'--------- --- ----- PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE 10-432 00 Building Permit Fees /40,50 ��_ 10-431 00 Plumbing Permit Fees _________ 10-131 01 Mechanical Permit Fees __ ____ ]0'2]0 01 State Building Tax (5%) 7�<�� Plumbing Mech 10-433 00 Plans Check Fee _91^33 Building Plumbing Mech 30-'202 00 Sewer Connection 30-444 00 Sewer Innpoction 51-440 Street System Duv Charge (SOC.) . 52-449 Parks System Dev Charge (PDC) Storn`'Drainage Syst Deo Chrg (SSDC) ^� ��'.� . = 10-230 09 TRFD 10 230 06 Washington County Fire #1 ( 10-120 00 Hu`art/Wedgewood TOTAL 236 85 0 _��5��z _~-------- • REC —-'—'—'---'--'----'------'------------------ APPLICANT SIGNATURE ,,i 8v /, Datv Received: 'o/350/y/\0p