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, � "" . � ' :� <br /> " _ .. .�j DOILDING PERMIT APPLICATYON . - � /9�0�;� . <br /> - , , : , : �pplicant To Complete This 9orm ��j���T <br /> ,� • � 1i more than one building is to be contructed, submit a separate permit applica- <br /> • . tlon for each buildinq. A separate permit will be issued for each building. <br /> �r= J'/10��2 MI}n1 (`P, e-� 9 � Baildinq Address <br /> , � , �ddress n( n2f� �- L}MS .�-/ �!'�Lot �"�D Slock Z L- - <br /> City >�/O_rL�1'�F" Phone 3 S� - f�'�O � 9nbdivision (Plat) . <br /> � - �scAitect/Enqineer � �;�r � & 2c.f- j����' `� . . <br /> • tr �.�r <br /> � �' ���� �tY hone Hetes i Bouads (Unplatted) <br /> _ L .3 <br /> :� tractor -fo FrlJ .- ��.�e ' -�Q- c a.7G_ Sec. _ nup, gQe .. <br /> _ - • 7lddzess ��lo -� IL S� . . . <br /> !; City �i/.(l��La�k, d Phone 7 � (�Z/�� Buildinq Use '�e �� � , ' <br /> 17 .�: . . ��,',�!6:�: <br /> r= State.License Number .1�-j -� y- �,�6'o peacribe Work to Be Done �' .� <br /> � : . .t L�piration Dat� \,l �'� � r� � . <br /> I <br /> �� ' � � � SICBTCfI PLOT PLAN BELOW' • ' <br /> . . _ ' . <br /> � _.� . . � Dse of Buildinq ��.�t�.e.,.f a , ' <br /> � ` \ ;. . : . �ev ❑ Addition ❑Repair/RemoGel <br /> 'g 1� � • � Valnation of Constzuction �/pd`r�� � <br /> �l <br /> . "�,.. �� . . . � ' . PLOT PLAN REQUI�xEP1ENTS 'g�/ C� . <br /> � • z- <br /> ��.: - <<;�dieate lot size, name of streets, <br /> � ' � . .(00 indicate location and width Af <br /> - � � � • � = � illeys, locate pr000sed and all � <br /> axisting buildings, show distances <br /> • � � � `�'! ' � � '± • � t0 prop�rty lines, show distances <br /> � � � � . • � between buildinqs. <br /> , ... � Lot aize x <br /> � ` p � � � Lot area Sq. Ft. <br /> � '. r - . r�,y� �y"' Size of Blr�— Sq. Ft. <br /> 'T � 0 Number of Stories <br /> `• i. � . 8asement <br /> r.. � .. <br /> '� �• Signed By �,D,,�, � � � <br /> _ �. S <br /> . - �,- �i��� �V rc: ��6 <br /> �d �. � � �_. Ow P one � <br /> DO NOT N:iITB B'cLOt�7 THIS LI:IE-70R CITY USz Oi7LY <br /> -- -- Date Received 7l S� � � � oc�e zone <br /> ' Plan•Check :7urbez Pire 2one - <br /> Yalnation ��L9'7� Oceuaancy Grou� <br /> O <br /> . PemiE Fee �� � q�rpe of Construction � <br /> llan Check Fee Ocwpaat Load <br /> . � total Fee Due G <br /> � � Spiinklers Required <br /> Oate Issued 7�.� '7)� ' <br /> • . —� . • - <br /> I <br />