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<br /> , . •! . — .. . . • Doir.oitac reru•�iT nrrLzcnTxo�a '. ' ' ' '; ����?�T
<br /> ' ^ � ' � � Appll.cant To Complel•c This :orm , ' • • c+/�i�
<br /> .. . � ' • . . . . � (�/�F/ i.7
<br /> � • • ' Zf m�re than one Uuilding is to be coniruct•ed, submiC a �eparate permit applica-
<br /> �' . : Qion for cach buildin.7. A separate ycrmit will bu issued For each buil.diuy.
<br /> . � � 6mer '�{ li4 ��(D� SL_� Duildinq Address �� �-riy, i � 0 i i'3 �
<br /> ,
<br /> � �� . �� ����
<br /> , � ., . bddr`� � 1 " 1} Lot. �o �llu��a�i Dlock '
<br /> ' � Cfty � , Phone`���YrLL"��0 Subdivzsion (Plat) . /�1� r�I�.�-l�� ' .
<br /> ' � Aschitect/.Enqinecr + � : ��(Rl,w' ��. . .
<br /> `"� City �_Phone \ :I•tetes L Bounds (Unp1aL•ted)
<br /> - - , '"i � �� • ..
<br /> : .��•. Contractor�j lp�l�'�_ c/�l( iu��Q_ �?: SeC. Twp. ' Rge
<br /> ' : ' �.'ddress �.I(".�-� ("� 4-Q l'1 40 h'1'�,l�i ,,n�. •
<br /> : • �
<br /> . !; :�tY t1D� C'}�, J .Bhonec��—�//�/� ,Bnilding Ose ' . . ,. t„� .�.
<br /> '�'i� � Statc.License I7mabcr ���-�G"���/��� Describe Itor}: to De .Done ��',�.�
<br /> _. � '.• �1 Expiration DIItL (�— � — �� ' � (��l ��51_9�i� �i� 1 Nr .. 1
<br /> ; i _
<br /> • �� ' ' � =� Sl'•I:TCII PLOT PL;.?i ?iELO�•I' • • � - �
<br /> .
<br /> . :A • . . • . ' . , Uce of Building � Cy.;`:e '
<br /> _�• � :: ' ." � � 171.ew ' ❑ nddition �Repair/Rc•mo5e1
<br />�� . �' . : • • ' . . ' :
<br /> ���• . " " • . , . - Qaluation of ConsLrucCion a,�,�n ��
<br /> o . .
<br />. - .. • . . • � ^ . ;;PTA't PI.RtV S2EQUIBL��'..7TS .
<br /> '„ • . . , . . ' . . - ' '.s
<br /> � � . .
<br /> := 1 • ' . ' � ' � ' Indicate lot sizc, nar.ie of streets, �
<br /> :� � • _ : . , : . • ' � ' ' �indicatc location zr.d width o�
<br />, �- • , alle.�s, 'lac�tc aroposc3 ar.d all
<br />�i , �''; _ . . . :. .exi�tin buildi.. ,
<br /> :�=1 .. .�� � -s=. sn�:: a,.��.��S
<br /> - `a �j= -.L-o )�roper:y lines, show distancc�
<br />� - . ': . ' . . _ . .
<br /> , , . .a ,.betwecn buildings.
<br />� _ - . ' . - . . :
<br /> � � Lot size x
<br /> , . •• . . � • . . • , Lot area Sq. P1:.
<br /> . ,•„ = _ . � • • .. . �Si2e of IIldg. . Sa. i't.
<br /> ` + , • ' Ituctbcr of Sto�-ir_�
<br /> :: . ; • . Base7ent
<br /> .,• _
<br /> + .:•.�- . � , tSi.gnc�c�IIy� •
<br /> • s . � . . • . Foi���,� ��L v._ - '
<br /> . . .' � , � • Oc�iner Phonc -,'�-7��/
<br /> �' ' PO NO�: 1C:i?T� 9'cT.007 TIiIS LI:IE-20R CI7'X USi{ OtiL'1 '
<br /> , Date ficccived ' � U�e• Zone . �
<br /> ' Plan cti��:: :�ur5e_ ' • r•ir� Zonc ' �
<br /> Valuation�� - �"� �C' _ Occu»7ncy Grou� �� '
<br /> 1'cmiti Pcc � � Typc of Ca�c;truct•ion
<br /> Dlon CLeci: L'cc � Occup2nt• I.oad •
<br /> . � jti?t.11 F�CC Duc � � �Spzinl:lcr� li��quired � ' :
<br /> Date Xs:ucd ' _ . � � ' . . - _
<br /> • • , ... � ' . • . . .. "; ' . ; • .
<br /> . '. . • .. • . . ��. � . ,
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