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<br /> .. �, F . . • ' DOZLDINC PERMZT APPLICATION . g,�'�" � . i,,,�
<br /> - " • ' , , � Applicant To Complete This :orm / / v: ,� ) �
<br /> ' - ' ` ' ' • /�1e?D�iS
<br /> , • u more than one buildinq is to be contructed, snbmit a separate permit applica-
<br /> . . tloa for each buildiny. �1 separate permit will be issued for each building.
<br /> . ' ; ' Ovner ��� „ /�� �z� 'n2c� Enildinq Address ��'7�/S� !�r<-.)=fi�. �� [ .
<br /> ' . iddress
<br /> . r.ot , 3 - � s�xk �/ ��
<br /> City Phone Subdi43sion fP1at) 1c,t� � �� " . -
<br /> ' . � � •
<br /> _ � • lrehiteet/Engineer ' �/2t �..�,�:�Z � . � • .
<br /> •✓ ".'� City • Phone Hetes i Hounds (Unplatted)
<br /> - - , i . _
<br /> :.': ContzacGor � ' Sec. 1F�p, Rge .
<br /> • � • . .
<br /> _� ;. . Mdzess � � ' •
<br /> �. �f City Phone Bnilding Use =•; '��-�
<br /> � -.;�.,..
<br /> � �'�;i � State.License Nuuher Describe Wozk ta Be Done (i c���� < �� �' Y
<br /> � : � 't Lrpiration nat� NL--Gu scr �'no�T � T�n � "
<br /> �� ' " • � SICETCH PLOT PLA.N BELOW' • "
<br /> _ . i • . , ,� .
<br /> . :; . . • . , . Ose of Buildirig �� � , � �1 c. ,� -¢ .
<br /> _ ►' � � . .,. ' �NeFt ❑ Addition �Repair/Remo�el
<br /> � �.
<br /> ��:• . ' • . � . • Valuation of Construction $ %6U•'� ��
<br /> '� . . j . .
<br /> ,,,�• . .. . � . . . . � � • � . P7AT PLAN REQUIR&�SEYTS . .
<br /> „ ' ' " ' '. ' . ' • � '.:
<br /> � . � � � ' .
<br /> :• � • , . ' � Znaicate Iot size, nane of s:reens, �
<br /> • � . .. '� • _ '. . . � ' ' " �indicate location and width of _
<br /> _ y. � . alleys, locate pr000sed ar.d all �
<br /> ' •'# existing buildings, sho:v distances
<br /> . , I i - .�-*"'-• -- �! . ' , ..~°+ . ' : . to property lines, show distances
<br /> , � . ' + ' . • betaeen buildings.
<br /> : -• • . . .
<br /> � . � �• _ Lot size x
<br /> .•. . s . . • • . . Lot area Sq. Ft.
<br /> • r, = . • � Size of 81 q. Sq. Ft.
<br /> `j , • Number oE Stories
<br /> , • ._ i• , 8asement
<br /> ,''::..�- - Signed By� ',✓Y��. lt:tl ic-�l "-rL-
<br /> • _: ' • . J
<br /> . . . _ For 2�z F�t �,2� -�-' /
<br /> .' � . . , . � Owner Phone .[_� -1{-/G-��"7
<br /> .. ' . DO :10T t�:tITE HELOt7 THIS LI:dE-FOR r_ITY USz O2tL'! ' .
<br /> _ Date S�ceived �C��ZC��7 �^ Ute• Zone •
<br /> ' Plaa C:uck :7ur:+er 7� �3�fCn ' Fire 2oue '
<br /> CJ
<br /> ,Yalva:ion C�C�. � pecuoancy Grou�
<br /> . • Pemit Fee �J< �� � �
<br /> Type of Construction
<br /> Ylan Check Fee Occupant Load •
<br /> . � 7blal Fee Due• � S i �� Sprinklers Required ' �
<br /> . . Datc Issued ��/2! 71� ' . • • < � .
<br /> � , ��� , <.� � ,, ,2�,-t- �
<br /> ' � � ;,> . ,� �. ,- , -
<br /> .. . . . : . ��'=/?'- %� . . ' , '
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