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<br />'� ' ' " ' ' ' EOZLD217C PEfiHIT APPLICA`fION ' � i, �
<br />� • Iy�plicant To Completc Thi� :orm './�'•���/ �' ��
<br />. . � . • • : � . %�3/7s'" .
<br />••' IL more than one buildinq i� to be contructed, submit a separate permit apptica-
<br />� .. tion for each building. i1 separate permit will bc issucd for each building.
<br />• , � �e= �Z„�e •, �. •�� �he � 8nildinq Address �,;� ��((L �C(Sk(e7L1�7
<br />� ' � • � llddress �l/., r�r��,k���rl �M,'.,ad Lot 7 81ock ' �,
<br />. City E�JE:�c Tr Phonc .3r; .i�6`i61 5ubdi4ision (Plat) Z.h.. �: ,. /�I d _ :
<br />. • •
<br />_ �sehitect/Enqineer _ 5�./� • • .
<br />• J+ �•'.'i City • Phone Metes i IIounds (Unplatted) '
<br />� ~ ;,' Contractor �je I � ' Sec. 1Wp. Rge '
<br />..� . . — . .
<br />=• %• . �� Eddress � ' ' •
<br />. '1 City Phone Buildinq Use %�r. �o�..,, ' ' '•: '�� �
<br />...�h� : •'�: � • . � . . . .
<br />u..;: ;..
<br />'� State License N�6cr Describe Work to Be DoI7C re,.ta�.�l ��' ,�
<br />' . Y ,
<br />; 'I E:piration Datr • �,�,��, d, r . .a��.�., '
<br />�
<br />��1: . . SRETCH PLOT PL,�!7 B£LO[P' • io ..,.��c1. 1��„�.� f' n,,.,.r.-.,r�,.,._ ..0 ` cnd� .
<br />'.r'.� ': • . . • . . � IIce of Buildiriq ��•�„n�.�� �..,,,.. _
<br />a' i � , ' • ' . � . .,. � ' I�New ❑ 1lddition Q Repair/Remo�el
<br />. . ,; ' � i.' • . � ,
<br />A � {• ' . � • ,' • Valuation of ConsL•ruction $ �Oo ��
<br />.� I . .
<br />y ' �. _ . � ' : • - .. , _ ... ' ' ' . . PIAT PI.AN AEQUI_Tt��IENTS . . ' .
<br />� . . . ' '•j
<br />Irdicate lot si.ze, nane of sr.reets,
<br />• • �•i' • ' ' ' ' •indicatc lccation and wi@th of
<br />j. .
<br />• ; � ' • _ �;� - �.. . . • alleys, locate nronosed ar.d all ` ' .
<br />' '' • Cxistinq buildinqs, show distai�cc�
<br />. . 1.'� . . ,-^` .•_.._ y . ' . ' . •'': . . t0 property lines, show distances
<br />, � , • •. � � ' , - , between buildings. . .
<br />. . '. , . . � ' . . . .
<br />� .� � ' �.• . , • . : ' • . Lot size x ' •
<br />• :.i- ! • . • • . . Lot area Sq. Ft.
<br />. r, = . . , • ' � � .Si2c of IIldg. Sq. Ft.
<br />'� , • • Number of Storics cn,�
<br />• . :: . j, � . . . . . - . • Sasement -- �
<br />`.r:' ' Siqned By <� .a f �l �,T7��- s-:,.
<br />. .a.- . : . .. , . FpI �n..�e] �'J �e�AE�
<br />ti ,
<br />. • Owner Phone �� 9 -,(4G 1
<br />DT_LOI7 THIS LI:JE-20R CITY USE
<br />Date .^.eceived �'-%I`��%�y
<br />Plan Check :Iur.Ser ' '
<br />U
<br />Yaluation r/,��• �
<br />Pcmit Fce 5, d� �
<br />Plan Check Fcc
<br />� Total Fcc Duo � � � �
<br />Date Issucd ._� ) - 7 �
<br />IIse 2one
<br />Fire 2one
<br />Occunancy Crou�
<br />Type of Construction
<br />Occupant Load _
<br />Sprinklcrs Required ' �
<br />. . . . •
<br />c
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<br />0
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