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Applicant To Complete This ?orm <br /> i�� �� <br /> If more than one building is to be contructed, submit a separate permit applica- <br /> �1/�5��� <br /> tion for each buildinq. A separate permit will be issued for cach building. <br /> LCA�c <br /> Oxner ����%'0' ^ � . M,_<,RT1N_ Suilding Address G.%1G+- ►�,12r>t�"�:�JAY <br /> Address �;' T �� Z Block E �i'' <br /> u- `I Z6 S S E • r,ot �� <br /> City �'/�Q�TT Phone�3 7- ��a-p Subdivision (Plat) ^�iF kC� T <br /> Architect/En�ineer • <br /> City Phone Metes i Bounds (Unplatted) <br /> Contractor Sec. TWp. Rge <br /> Address <br /> po� ;u i'Y?L`sC S�'� <br /> City Phone Suilding Use �.GT�',"-� �'l �`__._s.��'•�� � <br /> State License Number Des_ribe Work to Be Done �r' 1'�=!` ;;��5^! � <br /> Expiration DdtB Sl �� �J�C C �' ���'tl L�-� �'.G y � <br /> SRETCH PLOT PI.AN BEL019 • a� � �Y F' ' C- +� �,�� � � ��� �� <br /> ( � VBITIC�'� S�l�G,�,• Uae of Buildinq <br /> I �� ��$U�C. �S� [�New ❑ Addition �Repaiz/Remode�` <br /> �' �� . -� �_ <br /> �� Valuation of Construction $ � <br /> IZ G. /I � �/,�,G• <br /> . PIAT PLAN REQUIREMENTS . <br /> r%'�L'�X�`���.G Indicate lot size, name of streets, <br /> -�- 1co = RcPA� indicate location and width of <br /> �� I�� ? j,� ;;M„x� alleys, locate nr000sed and all <br /> ,� existing buildings, .shew distances <br /> � _ � ,� to property lines, show distances <br /> �o�� etaeen buildings. <br /> �o i / <br /> {s�Lz ' l� �y rJ,ot size �('j x �Z Ci <br /> � �S� pe�� �rf ks iJZot area f�Cif_�� Sq. Ft. <br /> �7 `i �( � � � ��Vy� Size of Bldg `. �����i Sq. Ft. <br /> �X;p� • �d�� Number of Stori� f � <br /> : � !oY' �. �,� � Sase�ent ..�,,, <br /> �j 1 / //� / ! <br /> � DU�� � ��$� � S1 gned By �� �-si ��Y . !' ii.�� ! <br /> j� (20liLW �`j For _ � <br /> — '"� Owner Phone '��> �' ' <br /> — i.i —`�. <br /> DO NOT t�7:tITS IIELOIa THIS LINE-FOR CITY USE O;JLY � <br /> Date '.o-:eivefl U-e Zore <br /> Plan Chec}: Ncnter Fire Zone G� � � <br /> Valuation I .CG� Occuoancy Group �Z <br /> Pemit Fee T �0= _ TyPe of Construction �, 1� <br /> Plan Check Fee � �1��_ Occupant Load . <br /> Total Fee Due i► Sprinklers Required i--�b I <br /> Datc Issued <br /> ���°,( �va�t�-l?� . <br />