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<br />� • i , � • � DOILDING PERMIT APPLI'^ATION / c7 �� .�. ' ' :,�
<br />, , llpplicant To CompleC 'orm l � . r
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<br />, •• 2i more than one building is to be ccntruc _.., submit a separatc permit applica-
<br />.� tioa for each baildin3. �1 separate permit will bc issucd for each building.
<br />. • dmer .� � ,'�/ L�c.-eGc_ 8uildinq Addresn �12c'�/ (�r.,�,/,,.1.,�,,.�.
<br />� � � �LGSS i�7G'�� �Jecu�r�/L N/[ E LOL � BIOCk ? � '
<br />Clty �G[r<•.i/` Phone Subdi4ision (Plat) � •
<br />, ' • �rehitect/Engineer • -� L� `-='�- ��-�-tic; � r� � /_�r 2(=. / /�' . •
<br />_ • t . . .`.'� City • Phone lietes t Hounds (Unplatted) ;
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<br />�. ;,'. Coatractor �f,crh''N<.�s�= Tf>i�i.:�•.�f.-,cY Ci, Sec. 7Vp. Rge
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<br />� +' ' �� iiddlC49 � ��� S n� . . ' ' •
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<br />.. '� City ��,<<:71 Phona.�:i-`j27,p BnildinqL'se • '�.•;:��,
<br />.'�l .: .,,:.. , . , _ _..;��,..
<br />'�� State,License N�ber ��/-y��s Descrihe Work to Be Done ;�cNocl= `
<br />, ...:i Lzpiration Oat� �— o/— 7L- /,,��v.' �(ir��_ c/ - i/�T r
<br />t.�' ' " � • S10ET^_}I PLOT PLAN BELOIP � • ^� ' '� �'
<br />' . ' � . - . .• • � . � .
<br />IIse of Buildiaq
<br />♦� i � ' .� , . ,. � ' �New ❑ Addition ❑ Repair/Remo�el
<br />. . . .; � . . � . • . . i' . .. '
<br />' ;. . " . . . • paluation of Constra�tion S ��"��
<br />. • � . .
<br />r.. . � � ` � ' . , � -� � . PLOT PLAN REQUIRE&'�.. TS . ,: .
<br />�� . . ' • . • . . . . . '.4
<br />:.� • � . ' Ii�dicate lot size, name of streets, �
<br />'. '� • • � ' �indicate loca:ion anz width of _
<br />• . � • _� - . _ • alleys, locate pr000sed ar.d all �
<br />• +•' � • existinq buildi.:gs, show distances
<br />. �� • . r- � : . ' . ��= . . to property lines, show distaaces
<br />� ; • .�•, � ' _ - betaeen buildings.
<br />. . �
<br />. �. ; , " 7.ot size x
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<br />a
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<br />n. - �
<br />� • •
<br />_ Date `:eceived l� �% �
<br />1�
<br />' Plan Check :lurber ' '
<br />� Valnation 1���• � �
<br />Yemit Fee I • �=
<br />Plan Check Fee -- -�
<br />� ibtal Fee Due l- �,�J
<br />/ i
<br />• Date Issued / L�Ic/7 1
<br />,-'7
<br />. Lot area Sq. Ft.
<br />Size of 81 q. 5a. Ft.
<br />Number of Stories
<br />Basem:nt
<br />Signed By � /%lr:.� f�'�G.` �
<br />For
<br />Ownez Phone
<br />OiIL'1
<br />Dce Zone
<br />Fire Zone
<br />Oecuoancy Grou2
<br />lypc of Construction _
<br />Occupant Load .
<br />Sprinklcrs Required _
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