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<br /> -- � . � . ^ .. • • IIUZLDI}:C P�iU�fIT APPJ,ICI�T'IOti • • . ��- �f-;, '�'-C'i,:.,i
<br /> ' , , • 8pplicane To CompleLc This L'orm , / �•� • � ; • ,
<br /> .• � � IY s.orc than onc Uuildinq is to bc ccntructcd, st:bmit n �ep�ratc pernit ��1�a�s
<br /> . , Yton for cach buildin�. .1 sepnrate permit will bc i::�ucd £or cach bui].ding.
<br /> ,� ���.
<br /> • , i Omer ,�ii'__ , � .-:. -
<br /> (d� , i���s l�i,-- nuilaing naaress , � . , � �r_r, �z«>��,
<br /> ✓ J� I
<br /> ' ".. . . �dCCu^S � '��/i� ' !.f; �� /�� � Y .��� .�0�. ���� Dloch C� �7 � �
<br /> . .r . . . _ .. .�. � C .� .
<br /> ,. City��-;c�"�l%;� Phonc�'�; =�.:=.-/ Subdivision (Plat) ` ` ,-�<� j�J •
<br /> ' • lschitect *'n inccr � � � • . �
<br /> /- 5.
<br /> ' `• '"� City Phone bietes 8 L'ounds (Unplatted) ' I
<br /> , ' i . . . . � ..
<br /> . ;,• Cont=actor Sec. Zt,2i. P.ge �
<br /> . . , .
<br /> � . , � � .
<br /> 1�dress -
<br /> -.Cit Phonc �\ 33uildin II,e ..%/` � , '���•.�• '
<br /> r y, 4 r' o-�.� r ' i _ ('L�,�yi ..
<br /> ' 'A1 .�: • • • • !' . •. �
<br /> _ -�'�:� f,tate Lic se 21t..^aber Describe S7ork fo IIe Uone ��� � i . � '
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<br /> �,�
<br /> • �I )�pir ion Dat� '�� � - - , � _
<br /> y1: " / . � � . . , � , -
<br /> � • SlII;4'Cli PLOi PLi,?I liELOI•7' •
<br /> ' -'j - • . . . .
<br /> _ • :.1 . . . L�e of Duilding • '
<br /> _�� � . � .�� . , _ • � �l�'ew �� ❑ Addition .(Y] Repair/Rc-moflel �
<br /> '. . . . - . • i' . .
<br /> � j� . � " ' ' � . � . . • • Qaluation of Construction $ ��;'�- � � �
<br /> - � � � � _� � . . . .
<br /> , " � , . . ,. � � � . , '.;PIAT PI.I�i FiEQUI?2�:E.iTS , _ �
<br /> �; -
<br /> :: ; • . ' � • ' Sndicatc lot nizc, nane of strcet_,
<br /> . 3 • • � . 3ndicatc location and width o�
<br /> • . . :� al].c��s, 'locatc aroposed a;.d a] 1
<br /> ' ''� � � " .cr.isting buildi:gs, shc:l di�t•�nces '
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<br /> ; ?� ' ... - .- •a • � ...: . . Lu property lines, chow distances
<br /> , ; � ' ^ _4 . • . bct�aecn building�.
<br /> � - • . . .
<br /> t . . . . • . S.ot size x
<br /> : •- ` ' . . Lot area Sq. Pr_.
<br /> ,�„ - . � • � . ��izc of IIldq . Sa. Ft.
<br /> ' : , • . Nwnbc: o£ 6Cc...,es
<br /> • =: . • Pasement
<br /> i.. � - � ' . ' � � �. .� .,. _ . �.,' YCc.�j�'
<br /> � ' ' � � . Signcd IIy '��i� ���C.��,,, �/ " �/�, /'�
<br /> _ . ' For _
<br /> . ' • Uwnez Pl�w�c
<br /> ' . . ' DO :d0": S}Y?T5 tJ�l.O!7 T1tI5 LI;4i>-'rOR CI7'Y USi: 07IL'L ' ' ' .
<br /> , Date `:eccived � � � Uce� 7.one '
<br /> ' Plan C:�ec;: :7ur..5er ' ' Pirc Zone ' �
<br /> \'aluation � Occuci�ncy G��ou! � '
<br /> Pcmit: Fcc � Type of Cnn.^>Yruction
<br /> Man Cl�ecl; 1'cc Oceup;�nt T,oad . _
<br /> , 5a:a1 1'ec Due r Sprinl:l.cr� Pcquirr.d ' _ .
<br /> L�te I::cucd __.._ __�__ • • � � ' -
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