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( , uuaa.uuw rcnrita I�1'CLll.fl'l1VlV . ' • �.1� •'. / . .�.�I
<br />i ' IIpplicant To Complete :itiis =urm '� ../ ;y '
<br />.. . i ' ' ' • /;/, . ,
<br />•' 2! more than one buildinq is to be contructed, submit a e arate ,, 1• .�
<br />' s p permit applica-
<br />.. tion for each buildin�. �1 separntc permit will be issucd For each building.
<br />. ; � Aaer � ��-�, � t � ."� r.//r r�. , Huild+.nq Pd3ress � %'� �� � � ��c �� - lS�i�i_..
<br />�
<br />. � • . lddress �� i� � ���- , Lot %/ slock ; %� �f - /� ��� G
<br />�tY L.-ri<'.-: � f Phone Subdi4ision (Plat) %�� �-� • /' �
<br />• , _✓- i ��_.� ( . ,
<br />, � • �xr�hitect/Engincer • . , � ,
<br />_ `.'�• : . `_'I ctcY Prone
<br />:! • i _
<br />:�'. Coatractor `,:�,-/,'. C-, "��r �
<br />..� , - i � �, � I r;,f'
<br />` ;, •` �' Mdress � '
<br />_ !- �. /([ `i ��c� „
<br />'1 aty Phone =, ���_ �'(. :7 J
<br />...4s I .._ - . .
<br />�- � r� � Statc.License Ni..^�ber .2 2,S -<��-�C %Z;
<br />.'. .�1 Yapiration nat� '/ i,� J G
<br />'��' . • SICETCH PLOT PL17 BELOTP' •
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<br />Ketes F Dounds (Unplatted) ' •
<br />Sec. 'lt�rp, Rqe , -
<br />Huilding Use • •:�'=••'-�
<br />_ ..�'
<br />. ;:•; ;..
<br />Describe Work to Be Done �.� �'
<br />. j �-_ j;..� //;�, ; � � � .. .
<br />/7 %/'/>� l� .5!>.�l1y'�.' s -
<br />Ose of Buildirig � , '
<br />❑New ❑ Addition ,(�Repair/Remo�el
<br />�� � � U
<br />Valuation of Construction $�
<br />PIAT PLAN BEQUI?2E?L:tTS
<br />� °�
<br />2ndicate lnt size, nane of stzeets, �
<br />indicate 2ocation an� width o: ,
<br />alleys, locate or000sed ar.d all
<br />existing baildinqs, sho:+ d:stances
<br />to propertv lines, show distanees
<br />betveen buildings. .
<br />Lot size x �
<br />.Iat area ' Sq. Ft.
<br />Sizc of Hl�. Sa. Ft.
<br />Number of Stories
<br />Basement
<br />Signed By .� �:7`j %� . �-� ��
<br />For
<br />Ownet Phone
<br />..� DO :IOT t�^2ZTE D'cL0[9 THIS LI:7E-POR CITY US' 027L'1'
<br />Da[c Secciv�d � Dce Zone . '
<br />' Plan CSeck,:iur,ber ' ' Eirc Zone ' �
<br />Valaation _
<br />Bemit Fce
<br />Ylan Check ecc
<br />. � Total Fec Duc
<br />Datc Issucd
<br />•. _
<br />Occunancy Crou� _�_
<br />Type of Construction
<br />Occupant Load ,
<br />SprinY.lcrs Required
<br />. . . . . �
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<br />0
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