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<br /> _- �. .. � � . - ' � DQILDINC PERM2T APPLICATSON . I. • :� /�j�/�/�A¢7��
<br /> . . � � , � 1lpplicant To Complete This ?orm • � � `^� �'1
<br /> , . Sf c�ase rh,� �;;� �J�I�inq is to be contructed. submit a se arate . i /
<br /> • : tlon for cach buildinq. .1 se arate P Permit applica-��
<br /> F permit will bc issued for each building.
<br /> . - � o,,,�r eo r� e.. . �!//�- /s
<br /> ; Huildinq Address ' 3�/ D �+Oq�a.y
<br /> . iddrese �A Q ro,�►�c�..w� LotZ }���/Y !
<br /> ��.�Block t7
<br /> �ty �� PAone �'_ j,�` S�3�visian (Plat) ✓<�s/f'
<br /> , . . � �/1�. C
<br /> . • Lrehitect/Engineer ' PL�7' � � ��� �+/�7
<br /> . _ � , d ,
<br /> _ .j City Phone Metes 6 Bauads (Unplat�ed)
<br /> , Contractor �',4.y(,� � ..
<br /> .. '-' - Sec. 1yup,�gye . .
<br /> � ' ' llddzess . •
<br /> � �tY Phone Buildinq IIse Q �F/�(:. . �
<br /> 1i . , _
<br /> 'j State.Licensc Nw�ber _ •• 'c�•� ��
<br /> , . � � Describe Kork to Be Done S'���
<br /> ' -
<br /> ;. �1 L�cpiraticn Dat� �'— ' �2�dT IC00� �.,,
<br /> '• p /,t/ FoRM6�C. S ?oQ�
<br /> . .`� � -� , � SICETCH PLOT PLAN BELOW' • �(�(�M4 �
<br /> , " I . - / I -7 • , -
<br /> : .� i -u. .t Oae of Building •
<br /> � • • aw � • I: : —
<br /> ,- . ' j � S: "� ���New ❑ Tddition �,Repair/Remoael
<br /> . � • . �� L � '
<br /> � � ;( 5 �- b :���d���alnation of Construction $�''�' �
<br /> ,...• � A
<br /> ,.�" . � ,i �.� .. ti.. • �J.� . . - PIAfi FLAN REQUZRE.�fENTS /i Y —'
<br /> i
<br /> � ' ' Iadicate lot tize, nane of streets, .
<br /> . j �✓„ -� •indicate location and width of
<br /> • ��� �y�. •� ' ; alleys, loc�te proposed and all ,
<br /> .. y ,_: �, �� existinq buildings, show distances
<br /> � t " to property lines, show distances
<br /> � . �
<br /> + . (�/ ,�� betveen buildings.
<br /> i ���
<br /> ' ' � Lot size .
<br /> ..- �- � � X
<br /> Lot area
<br /> �, r.. �J ��w� �� ��✓t�'�-si �1�' � ,� S3.ze of Bldq. Sq� Ft.
<br /> ' •. . i `, r/ �.,,,�C ��/ d,f/.,,i��..�„� Number of Stories 4�
<br /> .:. �. `�^*�e-- �.:se.�/�� ��� � ����. , Sasement
<br /> ,, i•._- �t.t�u'-r�� CwGP+ yu-s'r`a �=�-�-'1 !,�""Signed By ���
<br /> � , D U
<br /> (+t��.,� `Iy dl'4��sr� U�-E-�. For �c!/l �( —
<br /> I • /���,.r..t�._. x� �"'� 'L'c�-�r�--++��-�. Own Phone � .
<br /> I � � , ' DO ftOT K3ITL BELOFJ THIS Li:�E-FOR CITY (ISE OiiL'1 �
<br /> - - Date raceived � 8 ) � p�e Zonc .
<br /> 2
<br /> ' Plan.C:zeck :Ia�ber ' �
<br /> Fire 2one � • -
<br /> �' � Valuation � �0 �P7 � � O�cuoanc Grou
<br /> .. ' • - - Y � _ � --Z _
<br /> Pemit Fee ' 7 � � -
<br /> i Type of Construction _ �J _ �. F.,��, ',
<br /> Plan Check Fee `--�- Occupant Load
<br /> �r�
<br /> . : Total Fee Due ��• �-- ' Sprinklers Requi�ed _
<br /> Date Zssued _' jJ,�j�j� . ��Y '
<br /> • . APPRQVED i'OR BUILDING PERMIT ; •
<br /> �. . .. ,
<br /> . . . � • , � �pate • � �°.• �1�
<br /> . . . . . • �.�y�.
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