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� • : � � SOILDING PERMIT APPLICATZON - � - - ' <br /> .. :' ' , �pplicant To Complete This ?orm � �,i <br /> � • Ii more than one buildinq is to be contructed, submit a separate pezmit ap�Tira- • <br /> . tlon for each buildin�. .1 separate permit will be issued for �rach building. <br /> i ' dmer G<`rx1� S �o��i�Vl�(�� Auildinq Address ��. 1b20 �'y��;�w,;a ' <br /> , � , bddress 191 5 Ag�b�1 A v� Lot'L(,'i-1 zg,l�} 3 a Hlock 3 1 �7 -- • <br /> City Lv<« Phone3�3 � 7�j '� �ubdi4ision (Plat) _�evo�re�o„4 �� � <br /> � . • Erchitect/cn�ineer ��v� �� c,��� � ' �����} . v <br /> ':• '"� City 5�i `\�c Phone i= n q'�b4-`3 Hetes i Bounds (Unplatted) <br />- - -j <br /> ;, Coatractor C� w a.�� Sec. ' <br /> 4Mp. Rge <br /> � ' ' Mdzess <, a v�+- • • . <br /> ' �tY Phane Buildinq Use (� �� �c<- • � <br /> .� :�. <br /> 1.� �: . <br /> �;j � State License Nuaber Describe Work to Be Done 'Z v.� ��oe•i '��� '� <br /> • : � �i E�cpiration DatE _ - Z��1 ���a�, � � <br /> �� ' � � SRETCH PLOT PLAN B£LOti' • - <br />. : . � • , <br /> : j � IIne of Huilding ' <br /> . . . <br />� . . . . , , . � ❑New ��Addition ❑ Repair/Remo;iel <br /> , • • •' �`` <br /> . : � • l�aluation of Construction $ -� ax� <br /> • . <br />"•.' � .. � • . ^ PLOT PLAN REQUZRE.`L',:ITS <br /> �.. . . . _ . . � . . _ . <br /> . . <br /> . � ' ' • Tndicate lot size, name oi streets, <br /> � ' � indicate location aad width o: <br /> ' • � ' _ . . • , allcys, locate pzoposed ar.0 all <br /> • � ;�,} : . existing build:ngs, sho:u 3istances <br /> • : " 'P . . �.'- • to property lin�s, show distances <br /> ' � � ' • between buildings. <br /> , . ' � Lot size x <br /> "' `- • . Lot area Sq. Ft. <br /> .•.. � � ' Size of Bldg. Sa. Ft. <br /> ` ' . • Number of Staries <br /> • ' ��; � 3 . . � Basem t <br /> :.. \� - <br />,` ._ ._. - �Signed BY -� � \� � <br /> ' • For 52.�•.� <br /> � Qwner Phone 3 S �, � �,� <br /> � DO NOT SC:22TL B�LOtJ THI:: LI:IE-?OR CIiY USB OtiL't <br /> Date ��ceived (!'�'�4��/S� U�e zorn � <br /> ' ' Plan Chec,: :tur.ber �]�Z 7( ' Fire Zonc � <br /> Valuation Occuoancy Group <br /> Pemit Fee <br /> Typc of Construction <br /> Ylan Checi; Fee Occupant Load <br /> 5bta1 Fee Due Sprinklers Required <br /> DaYc Issued � • � � ' � . <br /> ` • . . . . ' � .. � � � <br />