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APn,ICATinN FOR BUILDING (ALTERATION 5 ADDITION) PERMIT <br />VILLAGE OF • M. <br />(Xner's Name <br />Address ^121 ._ _ _ <br />/ / <br />Builder's Name <br />Address_ _ _ <br />Phone i <br />$ / <br />r * <br />Nb. 37*-' street (?^SCO <br />- Block 4 Addition QA'TCC} UiaJitH, <br />Location of Lot: Comer Lot Inside Lot 5 <br />AILMLot Dimensions: Front f€0 Rear fl4>^ Side tyg <br />Structure Setbacks: Front Rear /Sf * Side /Z <br />Wetlands: Yes No ^ /jrea if anv <br />Lakeshore Lot <br />Stoc , <br />Aaaa <br />Lakeshore /Z ^! <br />Special **rovisions: Variance: Yes <br />Date Approved <br />Lot Changes: I <br />Type: <br />Comb.Div.Date <br />Applicant attach to this font two Certificate of Survey of lot and proposed building <br />location dmwn on these surveys. Also attach two sets of building plans. <br />^”*P®ction before permit is issued. Residential - 2 davs. Com- <br />flircial ar^ liuiustrial - 2 weeks. Plan Check Fee sust be submitted with application. <br />Plan Check Fee - Residential - SOI Building Permit Fee <br />Conaercial % IndustrUl • 6SI Building Penait Fee <br />Description of Building: <br />To be used as: Htf^S <br />Dimensions: Front ^ Depth Hei^t <br />Sq. Ft. /Z ^Dom*J <br />Cu. Ft. <br />FFont fpth Height <br />Sq. Ft. <br />lypi' of Construction <br />C . Ft. <br />Estimrited Cost <br />FfUmlted Complotion Dote <br />The layersignoil heTeby imkes application for a building nermit for the work as herein <br />*P*cified, agreeing to iU> all work In strict accordance with the ordinances of the <br />Village of Orono and rulings of the State Department of Fkiildii^ Hereby declares <br />tnMi All facts and representations statCNj In this appllCiitiQfi are true and correct. <br />Dale: <br />T <br />signatuff <br />^rmit Fee Plan Qieck Fee