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P - 75072
.. �.y+� �•5"cry� .�tr�eli°'ke$C�`r�`R'�x,.��.-i_;:-r, -"4 e:; .�h.; , � . . - . ' � r� � . � . . � . . .. ���-. . . ` . '"�� . . � CITY 0F Fq.l���if � ..� :'i,:�4#�."� _ .' 1.. . .. � . wa�� � �1;�!�'�wt��. c��ri��l���t�-d� ` �.� APPL�CRTiOM � " ' ' ,""`."'� . . N�: `�c� 7 � "L.�1 �,0 E'�d� ;� t�ate: -'�� "0�9` :::,���' '. (Nom. own.► P�u ► .,o� �e�: �- i � �,,� . LEt�Ab.�DESCRIPTION � " ��OCK PEftM1T: � r� SEYMEII: � WATER: `�' METER: ' FEEfc �7G _�LJ � FEE: ����� OEROSI�:_�� � 0-DIMTEii:..*._— STATE BTATE "D SUI�HARGE: SURCHARGE: TOTAL:�'�'��� TOTAL:IS � T=i�AL: �DC.1. �..��. � r� �1 ov �� GRMVp 7pTAL: �,=.. $,A.G. CHAR�'sE ON �XISTING STfWGTURE: � EX{ST'ING STRUCTt#RE: .,...,.._,,;�EW STRUCTURE: `' .: 9q R" BUILDING PERMtT No.: °�" �F° SEWER/WA �R P�E�R�M/!� 3 SPECIAL ASSESSMENTS: Signed: ' �`�'�*'`T •�-ss�'7 -��v: ��. ,. � �