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<br />_' � •• � • � � • : Jlpplicant To Completc This :orm i ` ' � � _ '�-�' .�
<br />. . � . . / � � .• . �2.,!: �•<' �' �
<br />•' 21 morc than one buildinq is to bc contructed, submit a �eparatc permit applica-
<br />� ., tiop for each buildin�. �1 separate permit will be issued for each building.
<br />' . � � Ormet �%{"/ %`���,s .%�C' Huildinq Addzess ��,��-'.i �tiL-c3t/,� �s���_
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<br />� . � 3ddresa C�'�• � /�,c1" T. �y �l�"�-� Lot / D elock
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<br />� , City �L-c�E �� Phone Subdibision (Plat) �� � (� S �' � i� �
<br />•' . irchitect/Enqineer % • �,�iC:t� �1'`` A`'%3 •
<br />_ �,'`. :, "_� City � Phone � Metes L Dounds (Dnplatted) � �
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<br />' ,;-: Coatraetor �/u£��S�I�C f.c�F /l,�G Sec. 'iVp• R9�
<br />= `:. .'' Mdress �S � � L�,;��Nul . . . . •
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<br />Y City �'�'� �' L� Phone -� � -/ � •5 C� Snildinq Use Ir� ;.S-pN�c� . 't':••� ;� �
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<br />• it � State License Nu�ber ?` '�� �-S �YS� Describe Wozk to Be Done ,',y�
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<br />. .�.� �zpiration DatE �� 1�C-I c;c�- .C,�;,Th /�; %�A(Z fv�?(:�,-f��y-J' �
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<br />' .,1.: ' • $RETCH PLOT PLA'i BELOlQ� • -
<br />' �-+ :� . . . . . . . . , � Gse of Build'uig �'LS,S7C'w'c" :
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<br />�, i � , " ' " , ' , , , • LINew ❑ lidditi on �Repair/Remo::el
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<br />' ' -•�, • • � , ' . : • Valuakion of Construction 5�,__ �
<br />' •.�. .. ' • ... : I . , :
<br />.�,�. . � - .. • : ., , . - ' . PIAT PLAN REQUIR&�tE:7'PS . -`.}.
<br />�, • . . � . ,
<br />` ' � ' SDdicate lot size, nane of streets,
<br />-� ; . - ' ' � : - •indicate locatioa and width o: -
<br />� .� ' ,' j • . � : ;',.' • _ ',: z� • alleys, locate pr000sed ar.d zll '
<br />. ;.� ' . . ' . existin9 baildi :qs. sho:a dis:ances
<br />`' � � ''n. : - -- ,� • � • .~', • to property lines, show distances
<br />' ", j �S . � � � ' • , betxeen buildings. �
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<br />Date �:�ceived
<br />1 Np:' K7LT� HELOt7 THIS
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<br />Plan Caeck :7ur.Ser
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<br />Yaluation —
<br />Pemit Fee � G • [��
<br />Ylan Check Fee
<br />, ; 1bta1 Fce Du
<br />Aale Issucd
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<br />Lot sue x '
<br />'. Lot area � Sq. £t.
<br />Size of B1 q. Sa. Ft.
<br />Nwnber of Stozies _
<br />Basement
<br />Signed�'
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<br />Own Phone ..'j _ - 79 ��-'
<br />IE-FOR CITY US
<br />IIce• Zone
<br />Firc Zane
<br />Occuoancy Crov� __
<br />'Pypc of Construction
<br />Occupant Load
<br />SprinY.lcr� Required
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