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HomeMy WebLinkAbout909 CENTRE AVE - APPLICATIONS - 5/19/2004 (9)L st First Middle Phone m c Street Address Please Specify: ILN. DR. CR. WY. PL. ST. CT RD. AVE. City State Zip Code 4Q f l6 &u.-1,tS 60 605Z Company Name License Number Supervisor & Cert. # `o R Mailing Address City Stak�ee __ Zip Code 10. 2z(o 5Z cc5 P one 2C)4. woo Please Specify: LN. DR. C WY. PL. ST. CT. RD, AVE. Zip Code 'q09 ('e Are 4V e - Subdivi5 on/PUD T of= ie,.#,CX -6tD C*D+—j" M3 e. PAalr �7 F CM T� - 1,4C. f�YA,a Filing Number L t to k Lot Area Building Square Footage Numbe of Stories Building Height Number of Dwelling Units Number of Bedrooms/Bathrooms Unfinished/Finished Basement Sq. Ft. A. Ul Stock Plan Number/Options Radon Energy Score/E-Star/Air Sealing/Blower Door Y/N Water Tap Size Sewer Tap Size Metered w A Type of Heat: Electric Main Breaker Size (Residential Only) Temporary Electric Pedestal Requested: © Gas 13 Electric ❑ 150 amp or less ❑ 200 amp ❑ other )(Yes D No 1 (Including labor, material, profit) $ 010 IS description of Work: ,, rr Job Contact Name & Phone W-01 I hereby acknow dge that I have read this applic ion and state that the above information is correct and agree to comply with all requirements c fined er n n inart and state laws regulating building construction. ,v w Signature CL Print Name Pho4 Distributlon: White — Office Yellow — Applicant Pink — WWW/Stormwater THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE '30 q 1V N