AF - 45589❑
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3a��7
City of Fridley, Minn. ,N•° 867'7
BUILDING PERMIT
��: � FEBHUA&Y 15, 1966
Owner: .. Builder _.____ P�ITOM�INC_..._..._...,...----....—.--
� __ � __ 8053 Bloomington Freeway _
Bloomington, Minnesota
LOCATION OF BUILDING
1624 (JARDBNA AVI3ftUE N.E. EAST 1/2 of
Na _.._�.__ 3teeet —�_� _ Pert oP Lrot _.._.._..___� T.�
Lot _.._ 34 .___ Slxk .�� Addirion or 3ub-Dlvlstm ._._��uditor's Subdivision 92
Comer Lot ___..__ Indde I.ot ._.._ R setbnck 37.35' -- gi�y� _._10.87' & 7.Ol" •—
sevr� neveaam �..___..._�._._ _._ Founaatica nevattoa
DESCRIPTION OF BUILDING i r�`f aa &'S'd
To b. v..a ..: zo '�reso 2%;fi�o
Dwelling _.._..� PYant �+4 Depth �26 Helght _� _. SQ. F't. __� Cu. F't. � �
Att. G_.._._araF°..� PYront ?�.�_ Deyth 22 Hei�ht 1Q 8q. Ft. __ 440 . Cu. 8't _.4,400
1y�pe ot Canhvction _._. Frame..__..._.� Eet Coet __..�.8.�00 _._.._ To be CanDleted —..._.__:
Ia e�d�ratloa of the lwuance W me ot a Pg�t to oonsteuat the bulldlr� deearibed above I agree W do
o�edlnanaM��� Shs dt�,y ���vlth ths de�crlDtlon ebove�fa com�Gl./, C.A��
m caoddaation ot th� D`Y�+t o! a tas of { 26.00 �t L haeby Qrantad M PBMTOM. INC.
�atruat ths buffdlni or addttlon as de�cribed above, Thb��( t 1s aranted uDam
eyeraoo to wh� it L araated sa8 hU a�ent�, emWu� and �en� in all work
dd Mu�i�� an' ecu'qr� thereof, ahall oonfa�+n in all rarDech to t6e aa�dinaAaea o�
` laxtlaa4 c�structtan, alteratton, matnteneace, reD�' +� +nm'1ai of b�
4 DK'�t m�Y M ievoked at +a4Y �e upon violatlon oi anY a1 ths provLdans o� wid
ALLSIQ G. JSNSSft 8� �
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APPLICATION F�t BUILDING PERDIIT
CITY OF FRIDLEY, MINNESOTA
UWNER'S NAME �E►.t? o u1� /.1C, BUILDEIt �E1�Li0 r.A , 1� C.
nnnxsss Bo53-�j,1,oµ,���-ro� ��z.U%� Aanaess
LOCATION OF BUILDING
G����u
of Lot
�qs'r 7Z or
L�l' tor 3{. SLOCK ADDITION OR SUBDIVI$ION AVDrfau.s Sv'$��vt5to� �`3�-
Corner Lot Inside LOT �Setback 37•3� Side-�Yard_IC�.g"% �� 7•E��,,,
SBTiER SLEVATioty FOU�VDATION ELSI7ATIOI�I
Applicaat attach to thie for�n Two Certificates of Survey of Lot and propoaed
building location drawn on these Certificatee.
DBSCRIPTION OF BUII.DING
To be used as;
j— � Nse. Ca....
S�q6l.G 1`"A�MII.Y ��,J�.aewlr�C�Frant q-�i-+20� DePth, Z/a Height 20
��_ -•� Sq. Ft, ��L� Cu. Ft.�� i5 d
.
S9. Ft.� �// Cu. Ft. T y C/��
Type of Canetruction�-+��,�,E EatimaCed Cost Z�,OAO
To be completed
�he undereigned hereby makes application for a permit for the work herein apecified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances
and rulinga of the Departmeat of Bnildings, and hereby declares that all the facta
and representatioas stated in thia application are true aad correct.
(Schedule of Fee Coats can be found on the Reverse Side),
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City of Fridley, Minn.
BUILDING PERMIT
��; � AUGUST 30, 1966
-3s/9oq
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Oamar: _ ..._., Builder PSMCO�ii, _�C_�.__..__...__....._—.....----..._.—
�� A� _ 8053 BLOOMCftGTON PARKWAY _,__^
_...—
BLOOMLftGTOIQ, NIINNSSOTA
LOCATION OF BUILDING
Na 1624 street �_. 6ARDSRA AVENUH N.E_�__»._ Part of Lot _.—.._. $���._.�.
Lot w 34 _ Block .�._____.�— Addttiam or sub-nividm ._�Aud . Sub .,�92 ---.._.____._
Cornet Lot ___..—.._.__ Indde Lot _ Setbeck �._ 8ideperd
9ew�r Elavatian ._._--- ----- Fouadatlar Elenatloa ..�._._
DESCRIPTION OF BUILDING
To bs V�ad ar. RENEWAL OF PERMCT #8677
Frant �— DeP� 8efil�t .,___ 3q. FG Cu. Ft
�._____ Frant --- Ikpth -- FTei6�ht __..._._ Bq. Ft _._-_�.._ Cu. FG ._...._
1j+pe o! �hvcHan _..._.FBAMF�..____..�. Fit Cast ��?$.., 000__._...._ 7b be CoanDleted _.�.�_.
m 000dd�ratbn ot the Ln�anae to me of a P�r+n1t to caostruct Uu bufldfni dacrlbed above I agree to do
tLe �copo�ed waet !n accosdsnca avlth the dbcrlptlon sbw���pt aad. �w�en� ���
asdin�nae� ot the dty of PYidlsy. / r_ (/1
� w .�1�/. Ai �
HALF OF ORI � FEE
In caodda'atlon of ths DsY�t o! a tee d li.? • 00�� D�t L haeM' i+'an�d 1'� vFNPCdna TwG ,
to constrnat the b�dldfna � additlon es descA6ed above. Thfs�e�{ t fa ¢rauted uD�
the a�r�r candttlaa that the to whom !t L ted aud h1t a�enb� ahR1c and �wrkmen� in all wo�k
aoms sw .rauna ana uyon ..��10�uuma�, or .nr sbe� .n.n aonta�a, ia a] �ve�e ro cbe o�a�nence. ad'
PfidleY� Minnaota looatla4 alteratton, mafnt�ance, rep�ir and movinY of b
�vl� dty ]imib� permfL m49 be x^evokmd at any Ume nPm vlolatla�n of W' of the Pa'�vlriaos ot
Q,AREftCE B&LISLE 8�� �
N�Nwle dw M wwe IM w�hMNN, M�tl� hr rYi��r �Miily. �r MNM�r wwM x wM�r. M wn b w�
N� Wll�ly MywMr Gr �rM� prrh 6► Nw Yra �
zy
APPLICATION FOR BUILDING PERMIT
CYTY OF.FRIDLEY, MIHIVB$OTA
OWNER' S NAML BUII,DER
ADDRE55 ADDRESS
LOCATTOA7 OF BUILDING
N0. STREET . PART OF LOT
LOT /a/i- BLOCK ADDITION OR SUBDIVISION "`-'�-�--✓ -�-' �—�
CORNER LO INSIDE LOT SETBACK SIDS-YARD
SEWSR ELEVATION FOUNDATION ELEVATIOft
Applicsnt attach to this form Two Certificates of Survey of Lot and propoaed
building location drawn on theae Certificates.
DESCRIPTIOft OF BUILDING
To be u ed as•
^\`��.�f- � � ' Front Depth Height
Sq. Ft,
Cu. Ft
Front Depth Height
Sq. Ft. Cu. F[
Type of Construction Estimated Coet
To be complet
The undersigned hereby makea application for a permit for the work herein
apecified, agreeing to do all work in strict accordance with the City of
Pridley Ordinances and rulings of the Degartment of Buildiqgs, and hereby
declares that all the facts and representations stated in this application
are true and correct,
DATE � ci G �o S
(Sched e of Fee Costs can be
found on the Reverse S1de}.
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��>,�- _%g � /4 � � —G'a.��:� n< « �/�� N� , ;.; =
�mpliments of North i entr�l Public Service�Q. 'Your Natural Gaa Company" G�.- �,$ 5..,
� _ y' i (��f' ! ' CITV � �; ,
f�AT F.,088 CALCUtr1TION6 - rowN
� DEPARTMENT OF BUILDINGS VILLA6H
Weathersttlps A.S.H.V.E. Construction No.� Insularion .
Guide
9ndows ��Doors Reference Out. Wall Int. Wall Ceiling R.00t F1oor Klnd How AppHed
�-No No 19....... � L�. I T{ �C F(�S ^� " ,-�
p !
� FL I 6,. � l�� oom Lengt idth -Fielght _ II � Fl. �. � oom I Length � S/- idth �/ - He14ht �"- j� ':
Windows and Doors-Crackage and Area � Windows and Doors-Crackage and Area � � � i
Width Height No. oP Llnealft. !u'ea Width Height No. of Ltneallt. Area
70_ ot pane ot pane Ilghts ot crack sq.ft. No, of pane ot pane lights ot crack sq. It.
� L �3 1'G ' 2 �5 G c. 6 •z �zK
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_ 2� 3 ��7 ��� �
. - Ccef.� Btu
nflltranon . �✓ �
:lass � � � � �i35�
:xp. wall X $
1et eacp. wall
nY. wall
;eiling � �' I
�oor ''� / x / / �1(� ',
'otal BCq. /
iequired aq. ih. E.D.R. or aq. ins. W.A. Leader area
Fl. I Room I Length Widfh
Windows and Doors-Crackage and Arna
Width Helght No. oY Linealft. Area
No_ ot pane ot pane ISHh oY crack sq. R.
2 � G � 3 �. 3�
1 z� � o / y/.y3�.�
�nflTtratlon � � � y �
31ass
�xp, wall x'
Vet rxp. wall �
[nt. wall
�eiling - � �
F'loor �- ( .0 / 2 7 S2 '
Total Btu. Y z
2.'_
R.equired sq. Pt. E.�.R. 9r sq. n. Wi .. der azea
� Fl. ye� Room LengUi Width ��
Windows and Doors-Crackage and Area %
Wldth Helght No. of Llnealft. Area
hts of craGC S4 ft
Inflltration
Glass
Exp. wall �
Net exp. wall
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d;:i 5:
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�(4 ��c �f
. L � fn / 7y Q h :_._.
Int. wall
Ceiling ��/1 �� .,�I
Floor � � y
Total Btu. > > � 1��
-}�-'� Required sq. ft. E. or i .A. I.eader arna V (
�elght � �- 1. I ,�/��. oom Length '� 'Width C� .- Height �'��.;'` .
Windows and Doois�rackage and Area . �-��� �-
r
No. Wldth Height No. o[ Llnealtt. Area �x ;
. 01 P�e ot P�e llghts o1 Crack S9yIG q k,����1
� - /o /O .S� 6 E � '�/� � .
1 =� -
%�' G
eE. Btu Cce1. Btu �:
D p 2 Infilhation� � / / �d�� � -��.
o r J class
Exp. wall
j,. 6L j� �( Net exp. w
No. I of pane o1 pane llB • . 5 B
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Infilh�aUon �� I `% ,�
Glass - �/ � 7 5�
ExP. � � .� li
Net exp. wall li
Int. wall
Ce111n8 " �
Floor �j / �c ��/3'f j
Total Btu. i y �I
Requlred sq.� rt'7�D.R: or sq. ins. W.A. Leader area
Ceiling
Floor
Total Btu.
U
Fl.�j � Rdom I Length��j"$�WidCh�� Height�8'� �
Windows and Doors--Crackage and Area
W1dth Height No. of LinealPt. Area
o_ of pane of pane lights oY crack sq. ft.
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Infiltratlon � �
Glass
Exp. wal} / 5' x � �
Net exp. wall . �
Int. wall
Ceiling / $�-� .t�/
Floor
�RL:
�.
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Total Btu.
Required sq, ft. E.D.R. or sq. ins. W.A. Leader area
i
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— ------ _— _._ _
----- --------� -- - - - -- — -- — — -----s
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�mpliments of North Central Public Service Co., �"Your Natural Gaa Company"
cirr
E�AT IA1S8 CALCITI.ATiONB - TowN
DEPARTMEN7'OF BUILDINGS VILLAOE
Weatheisq�ips A.S.H.V.E. Constructlon No. Insularion
Guide
; .
- —
3ndowa �Doars_ Reference Out. Wall Int. Wa11I Celling I Roo1 Floor � I{ind How Applled ,-.�
�;
es-No Yes-N 19........
FL Q oom I Lengt ��Width _ HeiBht Fl. I . Roam I Lengih Width Fleight �,-:�..
Windows and Doors-Crackage and Ai�ea Windews and Doora-Crackage and Area . �� .
W1Ath Helght No. of Llneal it. Area Wldth HeIgOC No. of Llneal ft. Ares �
Qo. o[ D�e of pane Ilghts o1 crack eq. ft. No. o[ pane of pane lights of crack sq. ft.
�.cl S7.s y� J�Y
. --_ � ! 6 . . . .
- Ccet.� Bm Ccet Btu :
, t
nflltrauon � '' 2yb y Inflltration !
:lass �� CJ SV Zo 00 Glaas t
�:xp. wall [/ .l� . . � >�� ExP• wall .. . �: :.
Jet rxP• wall �� � � 2 /� 2 D
Net exp. wall � - e:.`
nt. wall � � � . . .. Int. wall � ' ��
;enmg . . .. . �3'L 8- �� o � ce113ng . . .. �f :� �.
?loor SF ��2'� � � � Sz � . Floor � � � '� �
� � � �
Cotal Bta v t _�� Total Bta
3equired s4. . E.D.R, or sq. ins. W.A. Leader area � Re9ulred e9. ft. E.D.R. or sq. ins. W.A. Leader area :
�'I. Room � Lengt (� -^Width �-Height � F1• I Room 4 Length Width Height f
Windowa and Doora-Crackage and Area }
Windows and Doars-Crackage and Area _
Wldth Hefght No. oP Ltnealft. Area . � No. Wldth He7ght No. ot Llnealft. Area � � P
No. . ot ane oY pane IlgOts ot crack s9. P0. � at gane ot pane Ilghta ot crncic aq. ft.
% �'� �! � � �fo � � `/ '
�
.. . . - !. Cce! . 9tu � � Ccet. Bhl • �. ! �. � .
Inflltratlon . � . . � L'r'j � $ � �L Inflltratlon � �
;
�lass � � . . . �� ,$i/ $O U G� � �;'`:'
- - i'�
Exp. wall X� /(2 Exp. wall j, .
Net exP. wall (� /O � Net exp. wall #';,.
Int. wall �� � . � . _ Int. wall . � . r,'.
Floor ; I I
Total�Btu. �
Required &9. n. E.A.R. or sq. ins. W.A. I.eader area
- Fl. �: /yRoom I Txngth,i�jlj�'idth�f
Windows and Doors-Crackage and Area �
�
Inflltrarion
Glass a
Exp. wall �+ ��f �i `�
Net exp. wall
Int. wall . � . � .
Ce111nB ` % y / �
Floor
Total Btu.'
.�a...,t.n,isn_ ft F.11.R. �ra
. SSIl
/3 a
� /2o O
ra
Celling
Floor
Total Btu.
equired sq. Pt.�E.D.R. or sq. ins. W.A. Leader ama I
Fl. I Room { Length Width� . � Height
Windnwa and Doors--Crackage and Area � ��
Width Helght No. of Llneal ft. Area ' ��
'o. of Pane o1 pane Ilghts ot craelc sq. 1t.� � � �
Inflltratlon
Glaes
Exp, wa11
Net exp, wall � .
Int. wall
Ceiling . � ..
Floor
Total Btu. � .
ce1.� Btu
I f
ft. E.D.R. or s4. ins. WA. I.eader area
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SuB�EGi
City of Fridley
ATTHETOPOFTHETWINS g�ILDING PERMIT
;,
� �� COMMUNITV DEVELOPMENT OIV.
r � V PPOTECTIVE INSPECTION SEC.
�
I �
� � �"'1 � CITV NALL FRIDLEY 55432 NUMBER pEV DAiE
�""'� � �'� 612-571-3450 9�0-Fi5 4/14/92
JOB ADDRE55 1624 Gasdena Avenue NE
1 LEGAL ��T NO. BLOCK � TRACTOR RDOITION
D85CR. E�i 34 Aud< SuU,.#92 �
2 PqOPERTYOWNER MAILADDRES$ Z�
Tom/Ruth Tauscheck 1624 Gardend Avenue NE
3 CONTRAGTOR MAIUDDRE55 � Z�
Ti:mbercraft Remodeling 215 Old Hwy 8&W, Ne*nt Bryghton
d APCHITECTORDESIGNER MAILADDRE55 Z�
5 ENGINEER MAIL
Res
8
9
WORK
❑ NEW �1 ADDITION
WORN
ruct a 26` x 1fi� Deck
USEFROM
STIPULATIONS See.notations. on Qlan;
� �
2128
R O.
� ���3
AvvPOVEO er
SEEATTACHED
SHEET
LICENSE NO.
633-8611
PHONE
PHONE
❑ AL?ERATION ❑ REPAIR ❑ MOVE O REMOVE
SEPARATE PERAAITS ARE REOUIRED fOR ELECTRICAL PLUMBING, HEATING,
VENTIIATING OH AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOI� IF WORK OR CONSTRUCTION
AUTNORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR li CONSTRUCTION
OR WORK IS SUSPENOEO OR P.BANDONED fOR A FEFlIOD OF 120 DAYS AT
ANV TIME AFTER WORK 15 COMMENCE�. -
I NEREBY CERTIFY TNAT I MAVE READ AND EXAAAINED THIS APPLICA�ION
AND KNOW TME SAME TO BE TRUE AND COfiRECT. ALL PROVISIONS OF LAWS
AN� ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITM WMETMER SPECIFIED HEREIN ON NOT. THE GRANTING OF A PERMIT
DOES NOT PFESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEI THE
PROVISION ANV OTHER STATE OR LOCAL lAW REGULATING CON-
STFJUCT�THF/PERFORMANCE OF CONSTRUCYION.
c�r
ro
N{
�������
Before digging call for
all utility locations
A54-0002
REQUIRED 3Y LAW
1 ISiAILS
�� $3r,Q11��
RMITFEE
$63,OQ
AN CMECK FEE
Li,cense SC $S, Q0
OCCUPANCVLOAD
CLL FT.
�FSTREEi PARKING
GAPAGES
1RTAX
$1,51
iCCHARGE
F�,�e SC $3,�
)TAL FEE
$�2.$2
-9 z
�W Il
ADDN
ALTER j
, CITY OF FRIDLfiY
STNGLB FAMILY AND DUPLEXES R-i AND R-2
Building Permit Appticatioa
�� � �� -�� :,., r. ��... � /
Lega1 Description:
Effecrive 3/1M2
Owner Name 8c Address: 7n KGt �1 e rif� Tel. !�
Contractor: �n � I,ti MN LICENSE #� 6 z Y
Address: S. Iti • uJ /..�cr' TeL iV (033 -�6 ��
Attach to this app cation, a Ceitif of Survey of the
lot, with tlie pmposed conshuction drawn on it W scale.
LIVING AREA:
GARAGE AREA:
DBCK AREA:
OTHER:
DBSCRIPTION OF IMPROVEMBNT
I.e�agth Width Height
I�gt6 WidW Height
Ix.ngth �� Width �_ Hgt/Grouad .�
Corner i.ot [] Insiide I.ot I l
Type of Constructiou:
Approx. Compl�ion Date: _
Ft. Yd Setback
S- /-
Sq. Ft.
Sq. Ft. 3 � �
Side Yard Sdbacks
F.stimated Cost: S �� 3C� � 1�
(Cost on Backj
Driveway GSui� Cut Width Nceded: _Ft + 6 Ft = Ft z$ =$
DATE: �/ L APPLICANT: !�,�_'"��' . �e1. 1i 633`p6 /(
—���
CITY USE ONLY
Permit Fee S C�.3� �� Fee Schedule on Reverse Side
Fire Surcharge $ .3 , O � .001 of Permit Valuation (1/lOth`Yo)
State Surcharge $ l r-S� $.50/$1,000 Valuation
SAC Charge $ $700 per SAC Unit
Licens$ Succharge $� $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Park Fee $ Fee Determined by Engincering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL $ �� ��2
STIPULATIONS:
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a�l a5
Building
Inspections
763-572-3604
763-502-4977 FAX
�..�
SITE ADDAESS II O��iiJ.1
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CER'IIFICATE OF
INSURANCE
� -PROPERTYT�PE-�
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
ROOFING
NUMBEROFSQUARES_
GARAGES
PROPOSED SIZE:
PROPOSEDE�IGH'I:
SIDING
Vinyl
❑ Aluminum
❑ O[her
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
t Mn ii--�NE
❑ OWNER �CONTRACTOR
NAME: �p1'V1 �'R\p7�1 TiAI)GC'1
ADDRESS: IIO.`�.�.�, UQlyd�ll, i�1
pHO� ��3-5-��-�Sy,`11
NAME��—Lll Y�I����� �
STATE LICENSE M �� _I � 1 1
ADDRESS:��o� �,�QC�Sdi� ttU
PHONE ��O�J' �� �Slii
� SfN6GE FAMfi.Y/NEW CONSTRIICT[ON �
❑ TWO FAMILYMEW CONSTRUCTION
❑ ADDITION ❑ GARAGF✓SHED
❑ BASEMENT FINISH ❑ ROOF
❑ DECK �S[DING
❑ NEW HOME WNSTRUCTION ❑ ADDTTION
6dalAIN7ENANCE/REPAIli ❑ REMODELING
❑ HOUSE ONLY
❑ HOUSE k GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
�Satirt
❑ Trim
❑ Fascia
WINDOWS
INEXISTINGOPENINGS �Yes �No LOCATIONOFWINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
G CHANGES @
? WINDOW TO BE IP
ALL FEES ARE
Permit Fee
Plan Review
F've Surcharge
Surchazge
License Surchazge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Permit No.:
Received
_EXPDATE _7"c7�— �L]
CTTY ��Q�) STATE�IP���I
: %tn� — �i�'1 � � S�i�'-L p
ES_._ . _ . _. . _ .. _ .
NDOWS
7 DRAIN TILE
❑ OTHER
rCihU fi
HEIGNT SQ F7
BASEMENT REMODELING 5[1BMIT�
1. Ezisting Floor Plan
2. Proposed flaor plan
3. List of savctunl members to be used
FOR NEW CONSTRUC710N INCLUDING DECKS,
RDDITIONS &P�RCHESSUBMIT�
1. Site PIaNSurvey showing the existing strucmres
and proposed project.
2. Two se[s of cons[ruc[ion plans
3. Energy Calcula[ions
ON VALUATION, INCLODING THE COST OF LABOR
� ��(USING THE 1997 U.B.0 FEE SCHEDULE)
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Conhactors)
$20D0 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engneering
Agreement necessary ( ) Non Necessary ( )
iHIS IS AN APPL[CATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
confonnauce with the ordinances and codes of [he City of Fzidley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all worl.yw_h}ich r�eq,,uire� ,r�e,v��e,w, �an�d )approval of pla/n�st._ 1 I� �(',
SIGNAT[1REOFAPPLICANT ��A1�M�K., UA/XAM�YRINTNAME �%,V�ISI�IYIP_CLI.�i.�IIDATE (Q �"l �1_