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<br /> . . • . DOILDINC PERMST APFLICA'SION . �'1 �� •' ..
<br /> ^ � .. � • : Applieant To Complete Thi.s :ornt • /�.. • �/�y��
<br /> . . � .
<br /> ., ' •• � ' ii more than one buildinq is to be contructed, submit r� separate permit appliea-
<br /> , , tlpn for each buildinq. �1 separate permit will be issued for each buildinq.
<br /> " ' pmer �� �- „ /p __�tl r; '-n � n� lnllding Address � .3 �� /� � r i3 y I
<br /> • . . ., I
<br /> ' • 3Edress Lot / `� Slock 1
<br /> • • � �ty ph�ne Subdilrisioa (Plat) �, �,: , : I � ' �
<br /> ' . . ' . C
<br /> ' - is�ehitect/Enqiaeer __ _ �1�* ' � '� * ''
<br /> . :, ' =•� �ty • phone __ Metes a Bounds (IInplatted) ^
<br /> - - . . _ ' ' See. q'wP• Rqe .
<br /> :! Contzactor ' . . �
<br /> _ , • , , ,
<br /> c. �... �� lldazess
<br /> . . ,: ' • ��
<br /> .. 't Citp Phone Building Use . :•:=.�-.::.
<br /> •:M1•. I�.
<br /> i� ,, . .a.�F r
<br /> 'r} � State,bicense N�aber Describe Work to Se .Done /3u[� D
<br /> � . 'I Lzpiration nat� • 'NEW ��=7or- T�oN,- STtrS
<br /> ��� • • SICETCH PLOT PLAtJ HELOt+T� • . • -
<br /> _. :� . . . ' .. . . • • : . • � ' ` „ •
<br /> Dae of Suildina fj� ., �,- ; , ,-
<br /> . . .
<br /> �, • • ' , ,,, • L�New ❑ Addition (�'Repair/Remo�el
<br /> : . i . Oi .
<br /> • • • •; . ' , ' , . Valuation of tonstruction $ ,200• '
<br /> ` !' - i , = '
<br /> �� . . � . , . . . � PLOT PLAN REQUI?2&"IEYTS . . • -
<br /> �. . ! ^ . , .�_ . .. , , ... . � ' • - - �•^ �
<br /> ... . '� . • • � - � .
<br /> � � . . �
<br /> . i , , . . , SAdicate i.._ si=e, nane of streets,
<br /> •' + " • - •indicate loca:ion anfl width of -
<br /> ' � ;'; alleys, locate ar000sed a.^.d all
<br /> ' ' � - � " • � � - � cxisting buildiags, show dis:ances �
<br /> . ;.
<br /> " i',� . ' •:w,: :.. .. y , • . •,~°a . . to property lines, show distances
<br /> , , betaeen buildings. .
<br /> . i. � �. � � . . . ,
<br /> � . _ , . Lot size x
<br /> � . ; �
<br /> � ' � . . bot area Sq. Ft.
<br /> .•. . : � � Size of B1 q. Sa. Ft.
<br /> , r . .
<br /> . . �-i � . . . Humber of Stories
<br /> _ .. 'i . • ' Basement
<br /> , .•.. -- . Signed By -� .-.�rv:.� ' � � _ -�
<br /> . '.• . ,
<br /> ; �, i
<br /> " '• � � Forl,�"a L �fi. ��� !-L% c,- - � �
<br /> ' , � � ' • Owner Phone
<br /> � ' ' DO NOT {C:t2T� BELOI9 THIS LI:1E-FOR CITY USz 027L'l �
<br /> : ` _ Datc �eceived l U1.� 7 1~ . U-e� Zone • • •
<br /> —~�_ � .
<br /> ' Plan Check. :7ur.Ser ,_(,`� 3 Fire 2one
<br /> Yaluation 7 l�l��• �''� _ Occunancy Grou�
<br /> pemit Fee GJ��� _ ' Type of Construction
<br /> Plan Check Fee `—� Occupant Load
<br /> , � Total Fee Due � Ss��/ SpYinklers Required � •
<br /> Date Issucd l� !7 J� • ��,f. .l� ., � •� . , '
<br /> . . , �'/;�' . •;r�`Z _
<br /> . .. ' • i`�L�j/,) , ,
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