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^Z'n R*c*ipt- <br />- VMUJUKi uniaaxtm <br />Xaltial ^Umtion t— >1S0.00 <br />(9SO.OO pax Moh additional varlaaea) <br />tanoMl Varlaneo raa I7S.00 <br />(no oliaiipo fxoa oxipiaal application) <br />Aftax-tha-faot rooa (Oonbla application fan) <br />#1378 <br />19 <br />■ita dddxaaa A(oO- tO'i-rrPr.-i-' >f. :, <br />fxopaxty Xdantifioatleo Mbax (P.x.o.) 3'- 1'g-S’-* <br />ohaak ona - txopaxty X abatxaot ox_ _toxxana? <br />Attaoh lapal daaoxlption to application iX not iaclodad on <br />xaqnixod aoxvay. <br />Phon« (hoM) <br />^ ^^ (^ ■ O ‘ M Phoiitt (ifork) (b ^ <br />AddCToat fkt'Xi-'T: ?Z citvt O^T?'->yrp-i sipi_5£3f; <br /><if diXXaxant titan applicant) fhena (Imm <br />~ - —_ _ _ _ _ _Phono (woxh) ^ <br />Addxaaai'^^>A - i <br />/ I c wP«t« Property Acquired _ <br />X ttiV (do not) nlao own tho ndjnoont pnreols of Innda <br />ProsoBt loning Dintriet <br />Prooont Uno of Proporty <br />.'w ; ^ <br />City I OLor-jQ gtB, g-g-g^ Q:£ <br />~ : J V <br />(aooth/yaaxL) .5 .vV <br />“l izC\ '>■ <br />r t>ir i ■ <br />oi..-:- <br />C -:r Kosidontinl <br />Othor (apoeify) <br />Sstiantod Construction Cost $ ocxj.^ <br />Ooseribo rsgusst in dstnilt u <br />Lot Aron <br />iotbsek Vsrisndss (, <br />Other _ _ _ _ _ <br />Lot Width <br />Front <br />__ nsrdeowor <br />•ido _ _ _hour)