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<br />' _ ;' ', ' , , • : Ap�7Licant To Co;apletc This =orm � �' � �j`r' � [�_�`' •
<br />i . • '/ '�/ - �' , % j .
<br />, •• If more than one buildinq is to be contructed, submit a se arate /�
<br />.. tion for each building. .1 se arate P P��it applic5-�� ,5-
<br />� p permit Hill be issued for each building.
<br />� . � ' O�racr i i � )1 /_ ( ��i / ( • r�� . nuildin nadzess � "" < <' �n T��
<br />� , .
<br />s �5/ i���� I � A/
<br />i .•; iGdresa,'�_7.�% i�% .�Ciiln�r'nnOr �li1F1y Lot Hlock '
<br />'- . . City '��_ phone ,�r5',� =� D Sulxii�i.sion (elat � ^ �
<br />� ,JF �- � ��,�,-r�:.�J
<br />.� ` � J�rehitect/Eayineer � • ' � // % �✓
<br />� /�__��'''l7aC ' /•��'; �'�:�.%: vJ_! � .
<br />- � 1 . • =i �tY • Phonc `Metes 6 I76unds (Unplatted) • •
<br />:., . . _ . _. . .
<br />_ .;�•. Contractor ' Sec.� �p, ?, gg� 5... •
<br />_ '+' ' .' lddress _�� `� it%`�" /(I� JQ •
<br />. - �
<br />. 1 . Cif} .. Phone . Fiuilding Use �'��Z�Ct�/ �,/C��fiL%'f'•. _,� �
<br />-•� .ri State. License Ncraber Describe Work to Be Done ~►
<br />p , i 7 L. ,-�
<br />; � i P.ipiration Dat� ,
<br />�%X/sTiNf ��i/iL�/i.✓L - %C �•�l'
<br />'��' , • • SICETCH PLOT PI.�N BELOT4' • ��� � /�
<br />_ J •: � . . . ' .. . . .• � i�_//�/T/ %�/r'/._• �'�L71'.��c)77 /,/_S _
<br />� Ose oE IIuildirig .SC/11,%L'G-- _(�Tr'ITi��i ���-
<br />., ��-r��,
<br />� t • ' � ' �New ❑ Addition �epair/Resao�el�L
<br />� f' � � . � . i• • �Valuation �f Construction $,���---C:
<br />� '� .. .. . . �
<br />.•�_• . e �� - � " . PLUT PI.1�N REQUI?tE�IENTS .
<br />_�., - � , '
<br />� . : . . . . .., . . ' ' �� . . `�.
<br />•'� �� • Zpdicate lot size, nane of streets,
<br />+ � • . � . • • -
<br />' � �' " •indicate lvcation and wid.h o�
<br />� ;. j � � - . `;: ^ .. _ : = j'. . • allcys, locate nr000sed ar.d all
<br />� +',� ' ' - ' - ' ' existing bvildinqs, sho:a dis:ances
<br />, . � � ';.,.: _ .. y . , `y ,
<br />, .f _ - .. . • •• � • . to propertp lines, show distances
<br />�.; �. _ bet-ween buildings. ,
<br />... ' . .. .. . • ;. . ' Lot size .G�,-�� � x / f'� �
<br />• � :.i- . � . � . . , '
<br />. . . • ' . ' . . Lot area �Q�i?i�0 � Sq. Ft.
<br />.. �.� r. • . ..`�,. Sizc of Bld4•' �/,�.�5.1' Sa. Ft.
<br />, �' • Number of Stories /�, ,�
<br />�•:. . = � i ^ . • .. • Basement `�'t'Y�k�
<br />, ._. , . .
<br />� ,�. � • � . ii � / /
<br />' , � • . � Signed ��1.'^.�,lO,���v"isf-Cf/�.G'7'7I� �
<br />a' . � • . ' ' �" . ' For � �; '�� ��C� �(
<br />' . . , ' . Owne= Phone �2E =�ZVL^/�
<br />� : . . � . ' .. • _ � , � ' . , ' ,_�j.t'CZ�Ci� .
<br />�• DQ N0. SCiIT* B•'OtJ T}iI'
<br />: _ _ DatC SeceivCd /� 3�-�7`-`-`.^
<br />' • Plan C:ieck :tur,Ser %�✓ �75 .•
<br />�C�
<br />� Valaati.on ,jC; �k��• �
<br />. , . � �
<br />Pesnit Fee i�.% G� Z1
<br />' Plan Check F� �2 `-��
<br />. � Rbtal Fee UUR %/� % e a��
<br />�•
<br />Datc I�sucd ���j 7,j �
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<br />�t7E-POR CZ'PS USz�OiIL'I'
<br />D�e Zone _� -Z�
<br />Firc Zane -�
<br />Occunancy Groc� _ � F_ t
<br />Type of Construction V- N
<br />Occupant Load • ��
<br />Sprinklers Reguired — '
<br />.• . •. . C17�' OF.'E�(ER�TT ,
<br />' AFP�tO�eD Fj;�R;�gUILD1NG PERMiT �• •
<br />_ " R,Ie_1L� ��7.� . gy �' C , '
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