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- � �' i ' , � • r 3pplieant To Complete�This :orm � / C y!'��',`l� . �� •
<br /> • � � � i /�7�7 s•-
<br /> � • Il oore lhan one buildinq is to be contructed, su6m3t a separstc permit appliea-
<br /> .• : tlop for each buildin�. .1 separate permi[ vill be is5ued For each buildinq.
<br /> � . ; ' Oraes � �� ��;��z..v,.,,,1�� Dnildinq Addresa ��'/ c•b'� /�.�i �'Ci � . .
<br /> � , �
<br /> 1 . • : iddres �,�c� ��.7'.�, ��� � Lot �� sloek •
<br /> , .
<br /> , • 1 ,
<br /> - , a� ��-s:,fCt'i thons.7s J-�1S _h Sabdl4ision (Plat) •
<br /> = , .
<br /> ; � � 3[eIIiLect/Engineer • /' �(i �(i� � ' . .
<br /> . f --1!''-�-�,
<br /> _ •'� , • � CitY � Phone ltetes i eounds (Unplattcd) ' • •
<br /> �r ;,• Conttactor �� ,:.i,� gec� � �� . �e� . , -
<br /> � � ' %'•`•'' 7�EEseas �`�d.5 l^.�.; ' • `
<br /> - '.; ;i �.
<br /> � .3 .'f Cifr honqj3`3 25.�4 nnildinq ose • • • ��•; ��'
<br /> :'. h .Ar• ��T. , , . .,�..h�, :y.'•,..
<br /> • � ': itata Licanae Nmaber De�cribe Work ta He Dond '�'����
<br /> . • , �� ' /
<br /> ,�• . �I lspisation Date • ' r',r.�i�s��� �f G./�� •.
<br /> .�
<br /> ��� :i - . ZRCICN PLOT PLA.H BELOtJ' • • . ' .
<br /> • �� • .�� • „ , .• • W� oi euildiag � �
<br /> , �} . . .. . . . . . .
<br /> ►' . � � � '�••; •;,: � ;�. � . .;, :(�sw � �ddition ❑Repnir/RemoQel
<br /> , . . .... , , ' t� ,
<br /> + ���• � ; « . '' " •�' . � • Valnation of Constzuction S � �C.�-
<br /> � . •�� � - � •.� •. . ., �. , ;: •-. � . . :LOT PIAN 1lEQUZREI�tENTS . , I}�
<br /> � • . � . . • . �•?
<br /> ;, � . . • • .:s: • . . ' � ' • ' ' 21►dicate lot size. nas�e of atreets,
<br /> ' ` ' •ind;cate location and width of
<br /> • • � ' ' , �r; � � .. : • ;+-;:-{� • alleys, lxate pz000sed and all �
<br /> ' i" • .,. • � • . � ' �' �xisting Leildinqs, sho:+ distances
<br /> . ::° � !�• ••^�"^ � '}. , , ' . . °� ' . . to propertl liaes, show distanees
<br /> • �. j ' � ' , batwean buildinqs. .
<br /> .�.: : , . .. . . . . • ; Lo! size ,S�x �� �' ' .
<br /> �,. � � . ,. ��
<br /> • , . ';.�- • . . • • ,• • '. Lot uea Sq. F!.
<br /> . "� �: • ' � . Sisc o! B q. • Sq. Ft.
<br /> . . �� I.. . . • •• � .. . .
<br /> . N{lII�BT Ot St0= 8�-
<br /> :� •i ' . ., . � y , . .• • . slilm6IIt • .
<br /> •`� ' .
<br /> '�:r� . ' • .• '. . iiyned 8Y � �s1Y,r.__ �-.-,-,.1=%
<br /> • 1� • � ' ' . . . • ' .� -
<br /> . . � . . • .. !or '
<br /> .' • • . Owner ona
<br /> .. � DO NOT S�':iITE H£LOFf THIS LINE-POR GITY USE'027L'1'
<br /> .. ._ • /
<br /> • . Dt�te Soceived � '� � ' pce• Zone • '
<br /> ' tlan CSeck aueber �'S—¢/ 1' � ' lire 2one • '
<br /> �• Yalnation � 5 U • � � Occupancy Croap �
<br /> . tetnit Fee � � � � � Yype of Construction •
<br /> ' =1�n Check Fee � ' OccupanE Load •
<br /> . ibtal Fee Due �_` • � � 6psinklcr� Required ' �
<br /> . .. ' Date 2ssucd • 7 ? ' .• . • . � . - .
<br /> � � � . .,. • . , • . � � ��" • ;., •,. ' � • . . , .
<br /> . � �� � , , . . � ; � . . . '. . ; � ' ' �� • -r
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