10116 SW WASHINGTON SQUARE_SQ II VISITORS ASSOCIATION rim, - — – -
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10116 SW Washington Square Road
sign (Wash. Cty. Visitors Asfoc.
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a1`'Lro/� �� WHITE Inspector Cupr
I RVJ V ;/ ^ t� vE LLOW Panninee
ot """ "" APPLICATION FOR Q4+ Dt! NG PERMIT PINK Tamporry E le
GREEN Ctrculan,.
BUILDING '
WASHINGTON COUNTY ADDRESS
DEPARTMENT OF PLANNING
DIVISION BLOCALITY
BM:."NL. NEAREST
CROSS ST.
IMMIIIIMIllbilll1113 WINNOW ..------- - r . _Y
FOR APPLICANT O F L I CENSUS GROUP TYPE ►Roc
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BUILDING // / '//.`�DI* `DWELLING UNITS ZONE
ADDRESS_fi' 1� „5-a) f�vl7 y AQ_ ._ _LEGAL DESCRIPTION v ZONING APPROVED BY OATL
TYPE OF SANITATION
r __ - $LOG.SETBACK PROM
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FRONT VW,. • Ls
awt,. i
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No OF SLOGS Trod T'. .of Existing fatback Highway • Yd • Total
AREA Of LOTHIghway Width From CL _
NOW ON LOT - _________.._
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USE OF
EXISTING BLDG...- _
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l lr+6TEL. SLOG.SETBACK FROM
OWNER .I �y ✓ SIDE PROP.LINE OF (cheat)
r" "Cbrr. /+ t� �D� 1� Typo of Existing attack Highway • Yard • Total
ADDRESS//ta a, SIN ,d//_N PIS ---—...... ....Highway Width tom CL
CITY&A✓✓/.-Ly - '----- I —— -
ARCHITECT TEL CORNER CUTOFF YES NO
or ENGINEER NO
ADDRESS c�arL �J n - 6
CONTRACTORMkt e/in 5.14) -,NO� .(/i{..I it_� _. f
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DESCRIPTION OF WORK
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ADO Al-TER
pp ppUEPAIR pDEMOLISH
IIZE T ' _____Ef_ _-f_nate -� _FEE FOR AMOUNT RECEIPT NO. DATE
NO.BEDROOMS NO.OP BATHROOMS ZONING COMPLIANCE
I USE OF SIGN DESIGN REVIEW _-___ -
�STdS1G?URE \ __.. '
I VALUATION S / Op FIRE MARSHAL __.
poo ao _
F.C. PMT. ST TAX ADDRESS
FEE f FEE$ FEE S
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS SYSTEM DEVELOPMENT
APPLICATION AND STATE THAT THE ABOVE IS COR _ __ _ _J
RECT AND AGREE TO COMPLY WITH ALL COUNTY OR - - - �
DINANCES ANO STATE LAWS REGULATING BUILDING
_CONSTRUCTION - --- -- ---1
SIGNATURE OFRMF"L . �s�'_u -r
PERMITTEE . . �,(�((�/!l�` ��r.•
rADDRESS I-INA I. INSPL CT IITN DATE —y
C- ,40/Yl/)Vrtc.al_ 5t-r SrVe."
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT V LIDATION I X 1111 I.,,I,
RECEIPT NO, DATE ITE LT IP T All DATE
i •-•. 11 2Aua 111.00 (-fltcr•
000000 07-02- f15 f i'I2y
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