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<br />' � ' ' �' ' LT)ILDItIC PLRIIIT AC['LICATIO'7 � � ' � ' � � T
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<br />•• � , • , � Rpplicant To CoinplcCc This 'lorm ' , . '.
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<br />, ••� Tl r.arc than onr. building is to bc contructed, sul�mit a separatc permit a�plica- �I
<br />., t1Gn fct cach builSin�. .1 sepaz�tc permit will bc i::sucd Yor cach building.
<br />. x �6mcr � i„�� %r�[ia✓% Duildinq nddres� � �%O% (�-�� �
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<br />_ . ldCrcas �%(7 % '�i,�f''-a�lc,+-�.t_� Lot �� Dlock �' Z �
<br />' � � City �'�c�� Phonc .-3� 3 ;l,//�' Sub3ivision (Plat) .
<br />� • lschiter,t/Erqinccr _ �.y:_.tf- '�. `UL � Z � •
<br />•:_ "_'j City • Phone Hetc, L 2�oun3s (Unplattr_d)
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<br />:' :,'. Cuntractor %3irt;-� � Sec. 1tm, . IIqe .
<br />; • . � .zawr��� G s a 5 «, 73�(•-�i . . � -'
<br />.. l -.City �/�i _ Phonc,3->'.3 � �/1 % �uilding Usc � �
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<br />� St:tc License t7�:..ber OcscriLc Work to IIe Dor.c �'''
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<br />: : 'I Ts,,i:aticn nata 'G��t�9/-'�.E•,l't-" �l�,�T%�L . .
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<br />��' � • SP.STCIT 3'i.OT PI.l.!! ?sF.I.O?�7' • Fi'��./-•.;�: �:7!/l�l � �,�if`?I'.'-F= Cf�Ni'�'�✓.�`.
<br />. c.� . . ' • ' . ' .. � Lf F-A.� ( iu j•� -b=N/ / i f ��1 :i .�[[� ,
<br />iJce of Suildirg
<br />�' • .. � .�� . ❑l.eN [7 Addition ❑ Repair%Rc�c;3e1
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<br />� � . " • � � . • • Valuatior. oS f_on�Lcuct:on $ ' � �
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<br />+, - ' , . • , , ^ . . -.PIAT PLAlJ R_�UIF:]_':�;:T5 , .
<br />` . ,•; ' ' ' ' ' Indi.cate lut si�e, na^e n: <.zcet�,
<br />� ' • - ' ' � •indicatc location ar.� h•ir:Ch'o_`
<br />' •� � .' . � � • � . • • : • ' allcy ., 'locztc a^opo�ed a: d a� 1 " �
<br />' '' � � � � ' � � .existing Gui.ldi :ns, sho:•i distances
<br />.. 3'� ' � ..�-"�•'-•'•'a . ; • ..~j+. ' -1:o pioperty l.ines, �hov dicLar.ces .
<br />, . . .a � . _ bett:ccu builrii:�gs.
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<br />. ., . ' � . . . . . •' ' I.ot �ize x -
<br />^`- � � ' . Int• er.ca Sq: Ft.
<br />• r.. � � ' � � Sizc uf I31dg. Sa. F't.
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<br />, Numbc: of Str,ries
<br />. :: . i . • ' Ilasei7ent �
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<br />:' • , Si�ned IIy _ .
<br />i . • . • � �'V J�,G(/-e,✓I
<br />• • • • �L For � .
<br />� . . ' Owucr Yhcne �,y-,y ti/y�
<br />� . � • 3JrJ' � U.S�
<br />.• ��_�__ PO NO"' l'::2?'P' `.�':AL7 TIf75 LI:Ii.-iCllt C_ iY USE O'1T.7
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<br />; Date 7:eceived 7! ucc zonc __ _
<br />' Plan C:ticci; :lu.Scr �— ' Firc Zonc '
<br />,1'a)uz•cion � �C�(�. O"� -- Occuu,�ncy Croup ^ '
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<br />.' Tct:�ili i'ce ` C� '��. _^'_'� Yj•pc �f Con .tn�ction
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<br />I l.�n Ci�ect; I'r. �— __ Occupir.l I.o. �l _^_ ` .
<br />�'ioti!. 1'ec nuc �� A7� 'v'-�' __ D��rSnt:]� r:, P.cqJrcd ----
<br />. ' I+atc J:.::ucd `��J•j \i- . , . _
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