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<br /> ^ •. } . . . DOILDING PERMZT APPLICATZON � .j � Q , �� , . •.�.�
<br /> _ • . . : llpplicant To Complete This =orm o �0��� �� �
<br /> , •• ' i! more ihan one buiiding is to be contzucted, submit a separatc permit app ica- �
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<br /> . tioa for each buildinq. .1 separate permit will be issued for each buildinq.
<br /> . � Ovner y , �, , , /(' �{r-z� n � /1 Lnilding Address '�`/.�7 f% �>r� �+�'u � al% � '
<br /> ' �ddreSs Lot ��L� —.� � Blxk f ci nr� ���.�'
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<br /> . City • Phone Snbdi4ision (Plat) �, r , ,- T 1 • '
<br /> � � , � . , . �✓" . . .
<br /> • �rehiteet/Enqineer /.�_l� c t-� -< r��t Z-. .
<br /> • t• `_'� Cl.tp • Phone Metes i Bounds (Unplatted) ' �
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<br /> � Contzactor ' See. 2vp. Rqe � �
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<br /> -• :• . ' llddzess ' • ' •
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<br /> . 'f City Yhone Bnilding Use ":_�£;
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<br /> �'�� State.License Ni..^�ber Describe Work. to Be Done /3 t�t/L D , ���� ~ '
<br /> � : �.� 't Lzpiration nat� ' NFw ScT oF GRon�T 4Tt�5 '
<br /> t�' ' . � SICETCH YLOT PLAN BELOW' • • . � ,
<br /> .�. ` :� . ' . . . . • IIae of Buildirig �; n , �(� .; ,. � _ � �
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<br /> �. ' - ' ' ' � , , , � ONea ❑ Addition ,�Itepair/Remo::el
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<br /> �. . • , . • Valuation of Construction S /5���
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<br /> �- . •- � _ .. - ' • , , PLOT PLAN REQUI?tENENTS • • '
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<br /> . ' • . ' SIIdicate lot size, aane of streets.
<br /> • ' •i • ' + ' ' •indicate location and width of -
<br /> . , 1 � - " - ' •j� • allcys, locate pr000sed a,^.d all ' -
<br /> , . .•� , : �" ' : , � �, existing buildi:qs, sho:v distances
<br /> i �„-... -� r- ,� , , .~'. . . to pzoperty lines, show di.�tances
<br /> } S - � • betaeen buildings. .
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<br /> . - . , . • . Lot size x
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<br /> ... . • • . ' • . . Lot area Sq. Ft.
<br /> . S � Size of Bldg. Sq. Ft.
<br /> .t �' � • � . Number o: Stories
<br /> • ' :: .�j � � . . .. . . . • Basement _ � '
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<br /> ,. � .'�- ' • Signed Hy t���<'�E;rIG� , ��
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<br /> . • , . ' ' . . _ For ��z_ F«��c%t_ ' �-L -'��F'E:S'l
<br /> • • Owner Phone
<br /> ' - DO NOT li:2ITfi HELO[�7 THIS LI:IE-FOR CITY US^a OE7L'L ' � �
<br /> . Daie Soceived C� .1 ~ Use• 2one • .
<br /> ' Plan C:�eck. :Iur.Ser Cb`-3`�f� Fire 2one '
<br /> Paluation � ��• �� Oecuoancy Grou�
<br /> Pemit Fee "� � �� ' TypQ of Construction
<br /> Ylan Check Fee Occupant Load •
<br /> , � Total Fee Due 5���� Sprinklcrs Required � .
<br /> .. • /c�ry�/7J' . .���,� `_y :,�"'. ,
<br /> Dase sssuca �_� r - • ,
<br /> • ' � ' S . . '1♦J/1y'. � . _ �
<br /> . . • . � ' • . �/�j,-:.'/'•`�� �I. �' ' •
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