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<br />FROM ealT <br /> <br />PHCifjE riLl. <br /> <br />651 42':3 :3629 <br /> <br />Rw:). D'3 20m 12: 53Pt'l P2 <br /> <br />G~~DING PERMIT APPLICATION <br />9ITY OF CENTERVI1L~ <br /> <br />SITE ADDRESS; 6812- 20th Avenue J Centerville <br /> <br />OWNER;S NAME: <br /> <br />(\';,:l,.nvc:..",,--\ ~~fL"-(L-'liI~., LL" <br />'Iaxmiuo.l T- ~t' '-- <br /> <br />PHONE: <br /> <br />[,.5 ( - (c 'GY - '":/C -; i:;, <br /> <br />LEGAL DESCRIPTION: LOT ~.._) BLOCK~) TRACT: PID 24-31-22-33-0001 <br /> <br />CONTRACTOR/DEVELOPER; Mu~..ller Pipe Line <br /> <br />PHONE; <br /> <br />CIVIL ENGXNEER: Hetro Land Surveying & Engineering <br /> <br />PHONE: 651-766i-01l2 <br /> <br />ENGINEERED XX <br /> <br />TYPE OF CONSTRUCTION: REGULAR <br /> <br />DESCRIBE WORK: Expand ParJ,ing Lot <br /> <br />CUBIC YARDS OF CUTS: 4190 <br /> <br />CUBIC'{ARDS OF FIl,L: <br /> <br />ZONNING CLASSIFICATiON: <br /> <br />I <br /> <br />APPROVED USE: <br /> <br />SPECIAL APPROVALS REQUIRED: ZONING <br /> <br />SOIL REPORT <br /> <br />RICE CREEK WATER SHED FIRE DEPT <br /> <br />OTHER <br /> <br />THE UNDERSIGNED HEREBY MAKES APPLICATION FOR A PERMIT TO <br />UNDERTAKE CONSTRUCTION AS SPECIFIED ABOVE AND AGREES TO COMPLY IN <br />ALL RESPECTS WITH THE BUILDING CODE AND ALL CITY OF CENTERVILLE <br />ORDINANCES AND TO ASSUME RESPONSIBILITY FOR EMPLOYEESj AGENTS AND <br />~TJ~""g~Nif~Af;JTt:}R;;J AND etJN~mNT ift) NEtj~SSA~Y INSPECTIONS. <br /> <br />,/1 <br />; / I! / <br />/~) /i [l~ II .". <br />)'"'-/ :-.,~ /t.J t-C.l"t <\~,- <br />APPL'I~stANT ' s /S:r-,GNATURE <br />f '0 <br /> <br />f .. <br />,/,;.;- //lj_::.7( 1/,;') / <br />/ <br />/ .'DATE <br /> <br />* * * * * * ~ * * * * * * * * * * * <br /> <br />*- * * <br /> <br />...t.,. ~L.. "'"" <br />'r '\'" '""'" <br /> <br />* * <br /> <br />* * * <br /> <br />~ * * * <br /> <br />GRADING PERMIT; $ <br />PLAN REVIEW FEE: $ <br />STATE SURCHARGE: $ <br />OT>>ER; $ <br /> <br />PLANS APPROVED: <br /> <br />BUILDING INSPECTOR <br /> <br />TOTAL PERMIT FEE $ <br /> <br />GRADING PERl'iIT NO: <br />