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! , . . 10ILOINC PEAMIT APPLICtITION '. '' .: ,.., ' ' .� .
<br />� . ! • � � • �pplicant To Complete This ?orm • � � ''.����--'• ��'
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<br />Ii tore than one buildinq ia to be contructed, submit a separate permit appl ca- �>
<br />„ tlOn for each bulldinq. 11 separate permit will bc issued £or cach building.
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<br />, �(`Ovnes .�c.�,�F'. � lj�rFl�e.I lnildinq A�idresa hwi3�.-,ti��.1��,.,�1 ._�.,:i�
<br />� . ; /EAress j'I�C i�����kr���l V�,,.��i _ Lot�__ �lock 06.�-'�-- � � .
<br />''.'� Cilp i V F �2E t f Phone ; hr- :i-! 3 C yc / s�ivision (Plat) ��K I-r nisa /� r/�,L' Il : -
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<br />'' ' frchStect/Enqineer `.,�,ne- '
<br />_•ti.��.`._`` City • Pbone Metes i 8cunds (Unplatted) _ '
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<br />;,• Cwtractoz S�a.�i,- Sec. ivp. 119e .
<br />a.. .:• -�' fddress .
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<br />i, City Phonn
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<br />�• �'�� ttata.Licenae Nmnber
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<br />. ::i�. �piration DatB
<br />_ •t�' : : i , • ER6TCEI PLOT PLA1J BELOW' . •
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<br />Suildinq Ose C-. �r', h� E �; l cc � c-1' ••''' :�:i.
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<br />Describe Work to Be Done G.,si�,;�i�o.,��.•_
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<br />Osa of Buildin +.,e /.',' F
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<br />�ev �1lddition ❑ Repair/Remouel
<br />•Valnation of Construction S S.vc�c.or� " •
<br />lIAT PLAN REQUIREhIENTS [ °
<br />' Indieaie lot size, name of streets, .•
<br />•indicate locatian and width of
<br />• illeys, '�ocate proposed and all �
<br />� lxisting buildings, show distanees
<br />. to property lines, shoW distances .
<br />between buildinqs.
<br />yo! size 5�.5 - x /SC
<br />Lot azea /� � 5-� Sq. Ft.
<br />Size of BI3q.' .5 7a- Sq. Ft.
<br />W�mber oE Stories i
<br />• ,Basement n/ ,.r F.
<br />�+ �' �.~ � . j ! . aiqned By
<br />r • �i ; :, . . . . � • •� t0! ���.._�,,. .� �i� �'i, i ,
<br />. . ' � . -P`- Owner e one ; � 's - CdI � 1
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<br />Date Received
<br />Plan• Check :7ucber '
<br />Valoation � 3dC�• �'
<br />irsnit Fce Z-� • ���
<br />' ' llan Check Fee
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<br />, � Soql Fee Due `
<br />Daie issucd _ S '�
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<br />Dte 2one •
<br />Fire 2onc '
<br />Oecuoancy Grou�
<br />Sype of Construction
<br />Occupant Load •
<br />Sprinklezs Required � • � T
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