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' . � ', • .• , . • EOZLDING PERMIT APPLICATION • ' ' .. �' .• .• � •r,•T
<br />.. , i . : l5;�liCant To Complete This : orm � '7' � ;',j
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<br />'. . !f uore than one buildinq is to be eontn:cted, submit a separate permit a�ca '�
<br />� . : tioa far each buildin
<br />,, 7• , 4r� 11 separate permit will be _�_;;�� ��� each buildinq,
<br />• �. ; ' ovoer �'-4i.,�-�j • ;C�,•.-7 .
<br />�� � 1, i� � �""� lailding Addresn � GG ' -�c���t.�
<br />. . , �ddresa _ � / cF' X . / '� /
<br />�� ,�/ *'f C v'zz-r� Lot �3 Hixk C%t°c, . p_ �, 0.,
<br />�' , �� -�`-�'C�/ Phone 3%-le S-3Y s�ivision (Plat) ��z r
<br />.. . `��.' ���-�
<br />_ • lrchitect/Enqineer _ , -.��„ t� ' ' •
<br />_� i.: •�='i City . Phone lletes i Bounds (Unplatted)
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<br />' :�' Contractor �Zii_�t�L _ • ' •
<br />• ..�. � Sec. �p, � �� `
<br />` -'' - �ddress . '.
<br />. f a� Phone
<br />• 4�
<br />, � .�r..:
<br />. y � Etate License N�mber . � '
<br />. ..
<br />: �'.i. �piration Dat� ,
<br />� , �\ : �"� , � r BRETCFi PLOT PLAN B£LpN' •-
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<br />' ,',� � - ..:*+ � - � �/.�:. .:�r�..
<br />i ' i`' . _. �
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<br />Date ��ceived
<br />��l_'. i� -
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<br />� • . .. . : '. �
<br />P1an.Check :7u�ber 7�= Z �� �
<br />Valnation "_�3�, ��
<br />Petait'Fee �. ��
<br />Plan Check Fee �
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<br />. .
<br />� Sbtal Fee Due �2 ���
<br />Date Issued '
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<br />, 1. , � :. •
<br />Bnilding Ose _��/�N.�c_,r, y�- . . . :t.:?. '
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<br />Dezeribe Work to He Dane '"':'�
<br />• :.
<br />IIs� af Building �
<br />� �
<br />'�n�y �iAddition Q Repair/Remonel .
<br />'Valnation of Construction $ ,Y S C • ••
<br />, lLOT PLAN REQUZR��LNTS �.�3�-'�, ��:
<br />' Indicate lot size, name of streets, .�
<br />'ittdicate location and width of
<br />' alleys, locate pr000sed and zll
<br />' lxiating buildings, show distances
<br />• to property lines, show distances
<br />between buildings.
<br />Lot size �X � �-,r . r�,1�,�c.�i .
<br />Lot area '
<br />Size of Bldq. S4• Ft.
<br />� Yumber of Storie— s — S4' Ft.
<br />�
<br />Hasement ��--�
<br />Siqned By � `��, i���� �� --
<br />For ..
<br />Owner Phone
<br />1E-r^OR CZTY USE 027L'L � � �
<br />IIce Zoae 3
<br />Fire 2one ; -
<br />Occuaancy Grou� _ j
<br />Rype of Construction � ._��
<br />Occupant'Load
<br />b�rinklers Required •
<br />'� ' .. eI,TY .QF CV.ER�,TT
<br />•�•�([�PROV�D.�FOR•.BUILDiNG PERMI?,
<br />' �: • Date.�.:��7i' '_ �Y • �� : _
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