HomeMy WebLinkAbout2007-Building (signs)
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OSHKOSH
ON THE WATER
Job Address 2400 S WASHBURN ST
CITY OF OSHKOSH No 126541
BUILQING PERMIT - APPLICATION AND RECORD
Owner C S I WI L TO PRTSP Create Date 08/24/2007
Designer
Tom Crane
Contractor LACROSSE SIGN CO
Category
254 - Signs
Plan
Type
o Building
M-3PO
. Sign
o Canopy
o Fence
o Raze
Zoning
Class of Const:
Size
Finished/Living
Sq.Ft.
Sq.Ft.
Sq.Ft.
Rooms
Height
Ft.
o Projection I
Unfinished/Basement
Bedrooms
Stories
Canopies
Garage
Baths
Signs
Foundation
o Poured Concrete 0 Floating Slab
o Concrete Block 0 Post
o Pier
o Treated Wood
. Other
Occupancy Permit
Occupancy Fee
$0.00 Flood Plain
Height Permit
# Dwelling Units
o
# Structures
o
Park Dedication
Use/Nature C-Store /Installation of Multiple Wall and Pylong Signs for Kwik Trip.
of Work
HV AC Contractor
Plumbing Contractor
Electric Contractor
Fees: Valuation $45,000.00 Plan Approval
Issued By: ~
--- . . '''-''
$0,00 Permit Fee Paid
$223.00 Park Dedication
$0.00
Date 08/30/2007
Final/O.P. 00/0010000
o Permit Voided I
Parcelld # 1325500000
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature
Date
Address
1450 OAK FOREST OR
AgenUOwner
ONALASKA
WI 54650 - 0000
Telephone Number
608-781-1450
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
CITY OF OSHKOSH - DEPT. OF COMMUNITY DEVELOPMENT
SITE PLAN REVIEW - ZONING
Location of Property: 2400 S. Washburn Street (Kwik Trip)
Date Rec'd: 08/15/07,08/24/07
Applicant Name: Tom Crane, La Crosse Sign Co.
Phone: 608-781-1450
Fax: 608-781-1451
Applicant Address: 1450 Oak Forest Drive City: Onalaska State: WI
Zip:
54650
Owner: Convenience Store Investments Parcel Number(s): 13-2550-0000,13-2550-0100,13-2550-0200
Zoning: M-3PD w/ Hwy 41
Type of Construction: Multiple signs for K wik Trip Gas Station
Compliance Checklist
Use
Lot Width
Lot Depth
Lot Area
Floodplain
Airport
Height
Front Setback
Comer-Side Setback
Interior-Side Setback
Rear Setback
Building Area
Access Regulations
Parking Standards
Loading Standards
Vision Clearance
Trans. Yard Standards
Screening
Landscaping
Lighting
Sign age
Mechanical Screening
Var.lCUPIPD Conditions
Other:
Comments/Conditions
NOTE: Wall Signs #1 through #16 and #19 through #20 are code compliant and approved (see spec sheet for
details.
NOTE: Ground/pylon sign #17 is code compliant EXCEPT a 30' setback must be provided from the property
line and must be shown on site plan. Revised site plan shows alteration. Approved.
NOTE: Ground/directional sign #18 is NOT approved. Sign exceeds the 3' overall height requirement and
the 8 s.f. area requirement. Revised site plan shows alteration. Approved.
NOTE: Ground sign #21 is code compliant and approved.
NOTE: Ground sign #22 exceeds allowable height limit due to airport height zoning regulations. Revised site
plan shows alteration. Approved.
***$25.00 review fee not collected. Applicant must remit payment prior to permit being issued***
***THIS IS A ZONING REVIEW ONL Y. CONTACT INSPECTION SERVICES (920-236-5050)
PRIOR TO PERMIT ISSUANCE TO DETERMINE IF MORE INFORMATION IS NEEDED***
Review Fee: $25.00
[8] Approved
D Approved w/Conditions
D Denied
D Hold
Reviewed by: Todd Muehrer
Review Date: 08/15/07, 08/24/07
Please contact the Zoning Administrator at 920.236.5057 if you have any questions.
REVIEW AUTHORITY
As per Section 30-5 Enforcement of the City Zoning Ordinance, the Director of Community Development, or designee, must approve all plans, except the following: (1) Alterations or interior
work when the use is conforming and when no change in use is proposed, (2) Maintenance items, e.g. siding, windows, etc., when the use is conforming and when no change is proposed.
COPY: Planning
RECEIVE~
AUG13Z007 ~
DEPARTMENT OF
COMMUNITY DEVELOPMmHKOJH
Building Permit Applicatti@rla\dditiOnS5 DIV THE WATER
If yOU are a contractor varticivating in the Permit Fee Account System and have adeauate funds, check here
if yOU want this processed through your account n
City. of Oshkosh
Inspection Services Division
POBox 1130
Oshkosh, VVI54903-1130
Phone: (920) 236-5050
Fax: (920) 236-5084
JOBADDRESS KwiLTvip - 2400~, k11_<d1-b(..t(~i
OWNER Kw;~-rvip S-tO V'esl"I.nc... J(P2~ Cb.k s+- La CI(OSS~1 WI 5LJ002-2/07
BUILDING CONTRACTOR LaCV'05S€. S0V\ Co. J450 Cbk fOYPs.+ hv.- OnCtlnsk'Q/ WI b405Q
ELECTRICAL CONTRACTOR
PLUMBING CONTRACTOR
HEATING CONTRACTOR
I am the:
DOwner
OR III Contractor
USE CATEGORY
DSingle Family DDuplex DRental II .:S is''' =::>
.:. Full description of work being done: ~nsto.Ha.*.~\i1 o~ new s~ V\ pac }e;Q.ge
~ hew s-\-oYe ICJCD-+~oV\ p~v aftllched. dVQwi h55 ~ spec _shp€:+.s
Anv work not included in this application is not permitted. Please make sure to attach your
Plan Submittal Checklist to this application with all the reQuired information.
Building Value of the job not including mechanicals $ -.!:J 5 ow
I
PLEASE READ. SIGN. & DATE:
I certifY the above information is complete and accurate. Any deviations from the above submitted
information may require additional permits to be obtained. I acknowledge and agree to these terms.
Name: Thomas Cral1e~
~/ (p]ease~ri/.t)> , j
Signature: (/ ~~
Date: 7-/tl-07
11/03
SIGN I CANOPY I AWNING PERMITS
Submittal Checklist
City of Oshkosh
Department of Community Development
Obtaining a Building Permit
Questions on Zoning Regulations
Inspection Services Division
Rm 205
Phone: 236-5050
Planning Services Division
Rm 204
Phone: 236-5059
Permit Issuance Hours:
7:30am - 8:30am
12:30pm - 1 :30pm
or by appointment
Office Hours:
8am - 4:30pm
Information Required for All Sign Permit Applications
Site Address
Sign Contractor Name
Property Owner
Electric Contractor (if applicable)
Information Required for Ground Mounted Signs
-Scaled site plan showing the location of all existing and proposed ground mounted signs.
Signs must be shown in plan view to properly represent their location and
distances to property lines.
-Setback dimensions to property lines.
-Location of signs in relation to parking lot, parking stalls and buildings.
-Size of the property (total square footage.)
-Design information for each proposed sign:
Overall height
Illuminated or non-illuminated
post / pole details
connection of sign panels to sign structure
size of the signage
foundation details
U/L or ETL Numbers
Note: Signs 20' and taller will require structural calc\lllltipns to support the
foundation, sign structure and sign connection details. This information may be
required for shorter signs depending upon Inspector discretion.
-Provide a summary existing and proposed ground mounted signs:
Total square footage of each existing ground sign and proposed signs.
-Cost of signage and installation.
Wall Signs - Signs that do not project more than 18" from the face ofthe building.
-Provide a scaled elevation drawing of each wall where a sign is proposed to be installed:
-Provide overall dimensions of each wall.
-Proposed signs must be shown on each elevation; to scale, dimensioned,
proposed copy and in the location they are proposed to be installed.
-Existing signs must also be shown on each elevation to determine total square
footage on the elevation.
-Provide a summary of wall signage for each elevation that signage is being requested.
-Provide the size of each existing and proposed sign and the total square footage
of the wall affected. (Wall area is defined as the area from the grade level to the
underside of any roof overhang or to the top of any parapet walls. If in doubt,
please call to discuss.)
-Indicate whether the signage is illuminated or non-illuminated.
-UIL or ETL Numbers for illuminated signage.
-Cost of signage and installation.
Projecting Signs, Canopies & Awnings -Those projecting more than 18" from the
face of the building.
-Scaled elevation drawing showing:
-Height of above sidewalk, grade.
-Size, dimensions and square footage
-Projection dimension from the face of the building.
-Width of public sidewalk from building or property line to the back side of the
street curb for signs projecting over the public sidewalk
-Sign copy and size for awnings and canopies.
-Illuminated or non-illuminated.
-UIL or ETL Numbers for illuminated signage.
-Cost of signage / canopy or awning and installation.
Temporary / Portable Signs / Banners
This type of signage proposed to be installed on the ground or attached to existing sign
poles, parking lot lights, etc. must submit the same information as ground mounted signs.
This type of signage installed on a building must submit the same information as required
for wall signs. In addition, we will need to know the period of time (date range) these
signs are proposed to be displayed, as temporary signage is limited to 90 calendar days in
a year.
Zoning Regulations
Zoning regulations pertaining to sign regulations and setback requirements in the various
zoning districts can be found at http://www.cLoshkosh.wi.us. When in the City's Home Page,
click on Municipal Codes and then Chapter 30.
~e<bv.iYe. 1,QSe CQl C(,c\Q-\-ion -lot 3YO'Nl d ~i9V)..<;;
August 10, 2007
City of Oshkosh
Inspection Dept
IVED
AUG 1 3 2007
COMM~~ARTMENT OF
INSPEcrION~~vEVELOPMENT
ICES DIVISION
La Crosse Sign Co
1450 Oak Forest Dr.
Onalaska, WI 54650
Ph: 608-781-1450
Fax: 608 -781-1451
(1)- Sign Permit Request: Enclosed Application form, sign drawings, site plan and spec
sheet for new sign package @ Kwik Trip 2400 S. Washburn St.
*base specs to follow for (2) pylon signs
Also enclosed: Erectors lie. application and required forms along with $75.00
If all is in order please call us with permit costs or if you have questions or concerns please
call Tom Crane @ 608-781-1450.
Thanks,
Tom Crane
La Crosse Sign Co.
SIGN PACKAGE SPECS
Kwik Trip @ 2400 S. Washington St.- Oshkosh, WI
July 19, 2007
Attn: Inspections
Qty: 4 Building Wall Signs (Aluminum stud mounted letters) Color: Red
Copy: Kwik Trip
Sign #s 1& 2 on site plan - 1 '5"X 9'7-1/2" = 13.68 sq. ft. x 2 = 27.36 sq. ft.
Sign #s 4& 5 on site plan - 2' x 13' 8" = 27.34 sq. ft. x 2 = 54.68 sq.ft.
Main Store total sq.ft. = 82.04 sq. ft.
Qty: 3 Gas Canopy Signs (Vinyl letters on steel) Color: Red
Copy: Kwik Trip
Sign #s 3,7 & 8 on site plan -1'10" x 12' 9" =23.75 sq. ft. x 3 = 71.25sq. ft
Qty: 1 (Gas price canopy sign) LED pricer unit "unleaded"
Sign # 6 on site plan -overall cabinet size: 3'6" x 8'6"
Actual pricer and copy is 32" x 60" = 13.33 sq. ft.
Qty: 3 Carwash Signs (Vinyl letters on steel) Color: Red
Copy: Carwash
Sign # 9 on site plan 1'7" x 10' = 15.83 sq. ft.
Copy: Carwash Entrance
Sign # 10 on site plan 1'7" x 21' = 33.24 sq. ft.
Copy: stripes only
Sign # 11
Copy: Carwash Exit
Sign # 12 on site plan 1 '7" xIS' = 23.75 sq.ft.
Total sq. ft on Carwash Building = 72.82 sq. ft.
Qty: 3 Diesel canopy Signs (Vinyl letters on steel) Color: Red
Copy: Diesel Exit
Sign # 13 on plan 1'6" x 10' = 15 sf
Copy: Diesel Entrance
Sign # 14 on plan 1 '6" x 15'= 22.5 sf
Copy: Kwik Trip
Sign # 15 on plan 1'10" x 12'9"= 23.37 sf
Copy: Stripes only
Sign # 16 on plan
Total square footage of Diesel canopy = 60.87 sf
Qty:l 30' double pole Pylon style Sign (double faced)
Sign# 17 on site Plan. Sign located on property.
, , (' ( II,: (' j, I ( (] I J II (' II J(' I If 'j
;;0'
Signage includes:
Kwik Trip Face @ 93" x 57" = 36.81 sq. ft.
3-prod LED gas price face @ 88" x 46" = 28.11 sq. ft.
Hot Food face @ 20" x 116" = 16.11 sq. ft.
Carwash face @ 20" x 92" = 12.77 sq. ft.
Electronic Message Ctr. Face @ 24" x 7'3" = 14.5 sq. ft.
Total Sq. Ft. on pylon = 108.30 per side x 2 = 216.60
~ t J.. Qty: 1 Directional sign (single pole ground) Colors: red on white
Q'<I Copy: Truck Diesel wi arrow
, lJ'-f~~O.J -----.sign #18 on siteplan 3' x 3' cabinet = 9 sq. ft.
Qty: 2 Carwash directional sign arrows (flat cut aluminum) Color: Red & White
Copy: Access to Carwash l' x 5' = 5 sq. ft. x 2 = 10 sq. ft.
Sign #s 19 & 20 on main building
Qty: 1 4'Carwash directional arrow ground sign (flat cut aluminum) Red & white
Copy: Access to Carwash l' x 5' = 5 sq. ft.
Sign # 21 on plan
Qty: 1 31' single pole ground sign (double faced) {
Sign # 22 on site plan. Located on property. 30
Copy: Kwik Trip wi Diesel & LED pricer unit 8' x 18' =144 sq. ft. per side x 2 =288
*Sign Drawings, Site Plan and spec sheet attached.
*Contractors license fee and application included
Please review and if all is in order call with fee amounts or if you have questions or
concerns call TomCrane @ La Crosse Sign (608-781-1450)
Thanks,
Tom Crane
La Crosse Sign Co
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CUSTOMER APPROVAL
Colms on sketch are only a representation of the actual colm of the finished product. This OTt11Jork is copyrighted oed may
1Wt be otherwise used without permission. It is the property of La Oosse Sign Co., inc., and must be returned.
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CUSTOMER APPROVAL
Colms on sk2ti:h are only a representation of the actuiIl color of the finished product. This artwork is copyrighted and may
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DISCLAIMER
Maximum USGS Elevations
2400 S. Washburn St.
N
A
This map is neither a legally recorded map nor
a survey and it is not intended to be used as one.
This drawing is a compilation of records, data
and information located in various city~ county
and state offices and other sources affecting
the area shown and it is to be used for reference
purposes only. The City of Oshkosh is not re-
sponsible for any inaccuracies herein contained.
If discrepencies are found, please contact the
City of Oshkosh.
60
,
o
60 Feet
,
08-16-2007
Scale: 1" = 1 00'
Source: City of Oshkosh GIS
DISCLAIMER
2400 S. Washburn Street
This neither a leQutly recorded "'-lip nor
il is not int~ 1:<:> be ~ ;rs '1m,
Thb i$ it of ",,,,,:>rds, <tall>
and in \I<lrioU$ counJy
and $lat" effices ami ether Sootc<'$
the area ShOWllllM it <s te be used fot mfurencll
only, The City o! Oshkosh Is nGt re-
headn c<mtaimd.
com;u,1 th'ii
of Oshkosh
of
1" ::: 1
08/16/01
r,.,.,...,-"1<~(V~ h" tl"'Y"tJr'Y<:
dl
La Crosse Sign Co
1450 Oak Forest Dr.
Onalaska, WI 54650
Ph: 608-781-1450
Fax: 608 -781-1451
August 21, 2007
City of Oshkosh
Inspection Services
Attached you will find the additional information required for the sign permit
@ Kwik Trip - 2400 Washburn St.
(1 )-Site plan showing the setbacks for Sign #1 ~nd #2~~6~
I believe we have resolved the height issue for ~which lies 1 lfport Dist.
According to the grading plan and the height limits there we can do this sign at 31 '
(2)-New drawing showing Sign #18 @ less then 8 sq.ft. and an overall height of3'
(3)- Listing ofUL #'s Sign #18 GX096452
Sign #22 GX096456
Sign #17 GX096453 Kwik Trip Face
GX096454 Hot Food Face
GX096455 Carwash face
Weare unable to issue you the numbers for the LED gas Pricers and Electronic Message
Centers as they are out sourced from Daktronics and we have not yet received these units.
We will get those numbers to you as soon as units arrive. Hopefully this will not hold up the
permit approval.
If all is in order please call us with permit costs or if you have questions or concerns please
call Tom Crane @ 608-781-1450.
Thanks,
Tom Crane
La Crosse Sign Co.
RECEIVED
AUG 24 2007
DEPARTMENT OF
COMMUNITY DEVELOPMENT
INSPECTION SERVICES DIVISION
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2400 S. Washburn St.
Page 1 of 1
Muehrer, Todd M.
From: Tom Crane [Tomc@lacrossesign.com]
Sent: Friday, August 17, 200712:22 PM
To: Muehrer, Todd M.
Subject: RE: 2400 S. Washburn St.
Todd,
I discussed this with my contact at Kwik Trip and it was detirmined by there grading/elevation plan that
the elevation where the sign is to be located is 828', That would allow them a 31' sign as I proposed in the permit
application. He said you should have a grading plan that was submitted with the original building plans if you
would like to verify this.
If you would please tell Todd that I will be sending him a site plan showing the setback of sign #17 at 31.26" from
property line along with an updated drawing of sign #18 at 8 square ft. and an overall height of 3'. That should
finalize all the requiements at this site.
Thanks for your help with this matter,
Tom Crane
La Crosse Sign
From: Muehrer, Todd M. [mailto:tmuehrer@ci.oshkosh.wi.us]
Sent: Friday, August 17, 2007 10:50 AM
To: Tom Crane
Subject: 2400 S. Washburn St.
Tom:
I discussed the situation w/ David Buck who you said reviewed some sign application from the past. We dug
though our archived files and have some contradicting information. We have submitted plan commission material
showing sign heights, etc. that indicate a 60' sign and we also have a document indicating a revised sign at 31'.
In any event, since we have conflicting information on file, please just confirm the grade elevation at the
proposed sign location like I sent to you in email information yesterday and make sure the proposed sign height
will not exceed the permittable height. Any questions let me know. Thanks.
Todd M. Muehrer
Zoning Administrator/Associate Planner
City of Oshkosh Planning Services Division
215 Church Avenue
P.O.Box 1130
Oshkosh, WI 54903-1130
Phone: 920-236-5057
Fax: 920-236-5053
www.cLoshkosh.wLus
8/21/2007
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KWIK TRIP # 457
S.T.H 44 & S. WASHBURN sr
OSHKOSH, WI
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CITY OF OSHKOSH - DEPT. OF COMMUNITY DEVELOPMENT
SITE PLAN REVIEW - ZONING
Location of Property: 2400 S. Washburn Street (Kwik Trip)
Date Rec'd: 09/28/07
Applicant Name: Tom Crane, La Crosse Sign Co.
Phone: 608-781-1450
Fax: 608-781-1451
Applicant Address: 1450 Oak Forest Drive City: Onalaska State: WI
Zip:
54650
Owner: Convenience Store Investments Parcel Number(s): 13-2550-0000,13-2550-0100.13-2550-0200
Zoning: M-3PD wi Hwv 41 /' AJo 'R ~'"".t- 'r"'Y ,,~,
Type of Construction: Exempt directional g;round signs for Kwik Trip Gas Station
Compliance Checklist
--
Use
Lot Width
Lot Depth
Lot Area
Floodplain
Airport
Height
Front Setback
Comer-Side Setback
Interior-Side Setback
Rear Setback
Building Area
Access Regulations
Parking Standards
Loading Standards
Vision Clearance
Trans. Yard Standards
Screening
Landscaping
Lighting
Signage
Mechanical Screening
Var.lCUP/PD Conditions
Other:
. ... ..
Comments/Conditions
NOTE: Per Section 30-37 ~(2)(e) these signs are permitted in the city but do not require a permit to be issued
provided compliance with ordinance is met
NOTE: "Truck Diesel" sign is 7.083' in sign area and is 3' in overall height. It will be located near middle-
most driveway and shall not extend into the right-of-way.
NOTE: "Auto Entrance" sign is 7.083' in sign area and is 3' in overall height. It will be located near southern-
most driveway and shall not extend into the right-of-way.
***THIS IS A ZONING REVIEW ONLY. CONTACT INSPECTION SERVICES (920-236-5050) TO
I DETERMINE IF MORE INFORMATION IS NEEDED***
Review Fee: $0.00
[8] Approved
o Approved w/Conditions
o Denied
o Hold
Reviewed by: Todd Muehrer
Review Date: 10/05/07
Please contact the Zoning Administrator at 920.236.5057 if you have any questions.
REVIEW AUTHORITY
As per Section 30-5 Enforcement of the City Zoning Ordinance, the Director of Community Development, or designee, must approve all plans, except the following: (1) Alterations or interior
work when the use is confonning and when no change in use is proposed. (2) Maintenance items, e.g. siding, windows, etc., when the use is conforming and when no change is proposed.
I
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La Crosse Sign Co
1450 Oak Forest Dr.
Onalaska, VVI54650
Ph: 608-781-1450
Fax: 608 -781-1451
Sept. 26, 2007
City of Oshkosh
Inspection Dept.
SEP 28 2007
DEPARTMENT OF
COMMUNITY DEVELOPMENT
INSPE0ION SERVICES DIVISION
(1)- Sign Request: Enclosed Application form, sign drawings & site map for your records.
These two directionals meet all requirements exempting them from permitting. This has
been discussed between David Buck and a Kwik Trip representative in regards to the need
for these two signs due to traffic flow problems.
If all is in order please call us or if you have questions or concerns please call Tom Crane @
608-781-1450.
Thanks,
Tom Crane
La Crosse Sign Co.
City of Oshkosh
Inspection Services Division
POBox 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax: (920) 236-5084
(f)
OJHkOfH
Building Permit Application O!\l THE WATER
If vou are a contractor varticivating in the Permit Fee Account Svstem and have adequate funds. check here
/r vou want this vrocessed throuf!h vour account n
JOB ADDRESS~k-rvi1:'
OWNER Kw' V'
CONTRACTOR hCA.
2yOO .:s. Wa.shhLt VI/) st.
Ye.::::, Tn c..
-5;91/\ Co.
/450 CJ:J~ FDvp-s-t])v.. Ona(a.sV(o.. WI ~:::l-lb9J
, ,
I am the:
DOwner
OR .. Contractor
USE CATEGORY
DSingle Family DDuplex DMulti-Family o Rental I!ICommercial Dlndustrial
Work being done:
o Addition
o External Remodeling
o Handicap Ramp
. Sign/Canopy/ Awning
o Swimming Pool
o Other
Additional information, such as plan submittal and approval, may be required before issuance. Fliers,
o Deck/Porch/Patio
o Driveway/Parking
o FenceIHedge/Kennel
o Garage/Utility Structure
o Hot Tub/Spa
o Internal Remodeling
o StairIHandrail
o Stove/Fireplace
o Wrecking Permit
located in the hallway, may be referenced to note if any additional information is necessary.
.:. Full description of work being done: Xns+oJ \0.+\0 h.. (Y.\-- (2) € X-eht pi- -\(()\rn fE',(/Ih\i4ih9
5i.9Vl~~ '859;-h- I :-5' J-+ei3h+. ~OCQ+to,^ \s In 0. V1v:9 ::pvablelrns w i+h. d ;vedt(l13
+'fU0Ks d-t- +hi:J {1'I0.o:.+IO/,\ nn~ V1eeds-to \\r\.3tGll~ S~V\.\V\.ovdev +o\vnpvav-e..
iYG\.+C;c. 1l()t},t.~p\ivn(V)(A~ a-pp'()VaJ wQ~.3lvev-, 6y~VicS~('~/PlolrIY1i~~pt
\11 E'~e o.ve h ()\n- I i+ S\5V\s
Anv work not included in this application is not permitted.
Value of the job $ 3. 000 (Value for materials and labor is required to ensure consistency in accessing permit fees for all
applicants.) .
PLEASE READ. SIGN. & DATE:
I certify the above information is complete and accurate. Any deviations from the above submitted
information may require additional permits to be obtained. I acknowledge and agree to these terms.
Name: -rh(}fYla.s Cane
(Please print)
Signature: ~~~
Date: t/-26 -07
3/02
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