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_. ' ; - � SOILDINC PERMIT APPLICATION � p2 i { <br /> - ' . , Applicant To Complete This ?orm � /1 -J ��'j <br /> . . � �9�s � <br /> • i! more than one buildinq is to be contructed, submit a separ.ate permit appl ca- <br /> , . , tion for each hulldin�. A separate permit will be issued for each building. <br /> ' ' O�mer �vAL44C�' F�e�FNkU�� L056 Duildinq Address � � � �=� �-hE�%NUI': <br /> ' , LdEress �3�%� �(��-`'TN(/T Lot� Block ���"'0 � <br /> City ���P�TT Phone ��5=-�3-�� Subdivision (Plat) Ell���/ I : <br /> ' � 1lrchitect/Enqineer KG N� � (1/1 `i( 0/i/ �j . <br /> • :• '"� City Phone — 8etea i eounds (Unplatted) <br /> - 'i <br /> ;, Contractor ' N U N� Sec. 1vp. _ Rge � <br /> , , . � ]Iddreea . • <br /> ' Mty '"� Phone "— Buildinq Use �`�t �(�/C� � :•;_: � <br /> t�, :. <br /> '� State License Numher � Describe Work to Be Done ' � <br /> r <br /> � : 1 �piration naL� ' �OUI�' C'ONC��TE FovNDATlOA/ <br /> �� ' � - b1�TCH PLOT PLAN BELOiJ' • U N F' � � W�..�i I EP�D O� N O V J E - <br /> � ' : ; . � Osa of Buildinq R�/pErv�� • <br /> � ; • . . . , . � �New ❑ Addition �Repair/Remo�el <br /> . . .; • 15a.�z <br /> . ` ; , ' � • . . • � Valuation of Construction $� <br /> �...• � � � � . . ' � ' P7QT PLAN REQUlREbffiNTS . <br /> � . � . <br /> . . <br /> � � � • � � ' � Zndicate lot size, name �f streets, <br /> • � • <br /> � j ' • ' indicate location and width of <br /> , .. , , alleys, locate oronosed and all , <br /> ''4 existinq buildir.qs, show distances <br /> _ . 1 1 ' '- '! : � • .�. • to property lines, show distances <br /> � . <br /> � betveen buildinqs. <br /> , � Lot aize '�0 � x ( �✓`- � <br /> •- ` Lot erea Sq. Ft. <br /> r„ = • � Size of B�dq: Sq. Ft. <br /> ' + • Number of Staries Tw O <br /> • � �.: . � � . . Sasement O <br /> :.. ' <br /> �� ':• �~ Signed By � 1 lN <br /> . '. �� 3ri}ME <br /> Owner Phone g",2- O 3 2 (�,• <br /> ' DO YOT {ti1T* B�LOF7 TNIS LI:IE-FOA CITY US^c OtlL'L <br /> Date �eceived f 7� , Uce Zone <br /> ' Plan Cacck :lur..ber Fire Zone ' <br /> —�(� <br /> Valuation l,Sz'), Occuoancy Crou� ___ <br /> , � � C)G' <br /> temit Fee ��, Type of Construction _ <br /> Plan Check Fee Occupant Load <br /> . � 1bta1 Fee Due ��- �v Sprinklcrs Required <br /> i . � � � <br /> . Date Issued _���7 f . . , _ <br />