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•1•ps is an or:01ne1 design end mue[no[be Designed:9/17/2007
All dimensions size desjgnanons given ero released or copied unless applicable fee has Prtn[ed:9/17/Z997
subjec[to Verification on lob site and been paid or job order placed.
.djustmen[to fit job CoodiNons.
- pp j Drawing to: 1
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113<"
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This is en Original design M must oat be Designed:9/17/2007
xvan are licsblc tea hee Printed:9/17/2007
AU dimensions.sire designatlorw 8 released or copied unless app
audbject to vein£.x Job conEit ioa and been paid rjob ard-r Placed.
El 3 Drawing N: 1
9n0.nSA3d iti[
— 154"
39" ----�— 39"
30" 21" i� 24"
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This is m original design and tnttst mt be Designed:9/17/2001
All dimensions size designadoas given ore released or=Pied unless applicable fee he a printed:9/1 712 0 0 7
aubjeu w vetificotlan on job sit.and hem paid or job order ploced,
adjustmentw fitjob=ndidoes.
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6 89" 24:"
This a an arigind design end must not be Designe 9/17t20D7
O°to°6 iv ere released or copied unless applicable The has Prin[ed:9/.17/2007
All dimensions size dev j. B been paid or job order placed.
aubjeu to verifiuuion on job siu end
adjustment to fit job conditions.
EI 1 Dmwin6 A:
ansnrwan lrh
crrror EN
Y
PUBLIC PROPERTY
. DEPARTMENT
a..wrsvonsont
wroe taow�e,u�,sn�r•
tw:V&,?4&m•FARW&?4&ft%
IN FOR T= REFAM
aLQYAJM=
DEyiOLMOM OR CHANGE OF USE OR OCCCPANCI Brno .
�.,r�S:' iLXi4TI1y�
1.0 SITE INFORMATION �
Location Nsmw g
----
Property is boated in a:Conservation Am YM HNforto District YIN
2.0 OWNER$W INFORMATION
11 Owner of Land
Name
Telephone: � 7G - �c�
3., COMPLETE THIS SECTION FOR WORK IN EISt1Nr3 BUILDINGS ONLY
Addition Existing .
Renovation j/ Number of Start" Renovated
Change In Use, New
Demolition Existing
Approximate year d Area per floor(st) Renovated
constructlon or renovation
of existing building New
Brief Description of Proposed Work:
--- -- ---Mail Permit to: -
What is"cuff"use of fire Buil bv? �
--------
Material of 9ukwv? M diwWNIO.hoW WAM units? L//:✓<�—
wVI the Bail V CGrdb,M to Low?ow? Ambeslm?
Atchb*d* ( )
Address and PAN — 501`
µsdwdes Name
gddnas and Phar � �'bj�0 1SaConobvcdon 14
LkWMr
d3 O HIC RGOWa�^ 5 0
E cost � /� Pend Fes C Cost
X on
Estln+atad Cost X=71s1000 RsaldstKisl
P.mt Fee= G Es*nss>d Cast X$111111000 Cammsred-
An AddNk"=6.00 in added as an
I AdmlNstrafte dw9s.
Make
mm that all flelds are property and Mbly wftn to avoid dNaya in Procaaln4
The wWwalgrad do"Eby apply for a Sulldin0 PermR to build to above III I
spseftadwo. Sipped under Pwwft of PWIL"