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BUILDINC PERMIT APPLICATION % P � �� <br /> . . . � �� Appllunt To Complete This Form 0 '/ <br /> .. . ' 3/r9/y <br /> II more thaa one buildinq ie to be eonetrueted, eubmit a separate permit � <br /> �• applie�tion for each buildiag. A eeparste permit will be iseved tor eaeh <br /> building. • <br /> - Ownee �;f�,[� , ��J_/� � Bnilding Addree��?3/ /�+L�o� %�1 <br /> � <br /> Addre�� Lot�_Sloek �- • . <br /> CIl��/i,.2�/i-, Phons��.,�—/4N�,$ubdivi�ion (Plat���-�1i./. ,�{..x� � <br /> Are�iteet/Englneer �_��� �����; . <br /> Cttp Phone Metes & Boueds (Unpintted) . � <br /> Contraetor/�,ri � �siv.iT'• 3ee. Twp._Range ' <br /> Addres�1�/o4 -.7eV� <br /> • 9:�t c b�y �� <br /> CilyFl/E=QEc77' Phont�ny=/4�7Building Uee (t�-���; _ �� _ , <br /> , S4te,Lteense Numbera,��,y-/4Q .. De�eribe Work to be Done '' 'i <br /> : £spiraHon DatF y-i,C G _ ,�T� <br /> SKETCH PLOT PI.AN BELOW � <br /> 'O�a ot Buiidtng /t�4:�/�:i��J <br /> ^ �( QNew QAddiHon �Repair/Remodel <br /> Owner � JG• �ll' ��T.(Z� <br /> � � Valuatioa of ConetrucHon S ��on • re��� <br /> \'dvMirn_._"__--'fam:L:.--_ "— ' . ���/ <br /> r�o, ck._ _._ . __ __—_r��d._._ :_ - _ ._ PLOT PI,AN REQUIREMENTS <br /> --r;, . ;, < c,,.— <br /> a-����n� I „ i �,;,;,:' � I r� ,�,� Indieate lot eize, name af etreete, ' <br /> j �`k;,:;i . '� � • iodieate location and width of aileye, <br /> - - --- � --- -�- - - loeate propoeed and all exieting <br /> 2 ��"-. ; buildinge, ehow dietaneee to prop_ <br /> 3 I u�;'_� ��-7-'f`�� I - •rty llnee, ehow dietancee between <br /> 7�__-�5—�_ , buildinae. <br /> Plan Chcck No. � <br /> ,s�i--- °�-- Lo! �iae � x ,� � .� <br /> � � Lot area ��z�,/� Sq. Ft. <br /> Sics o[ Bldg. T. 3�_Sq. Ft. <br /> Namber ot etories �O��Q <br /> . , . � . Huement_GZ.2,/y . <br /> � <br /> ' r Si�ned By� �i Date��/7�y— <br /> a <br /> • Por �-�• lJ.D� <br /> • ner Phone.q�;�5- /,(�7 <br /> DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY <br /> Dala Received .J- �' �� Uae Zone <br /> Plan Check Number Fire Zooe <br /> VdwNon /2, ��'� " � <br /> Oeeupaney Group. _ <br /> c> U <br /> P�eml! Fee � ��' Type ot Conetruction <br /> Plan Check Fee � � Oceupant Load <br /> Total Fee Due �C�• �� 6prinkler� Requited <br /> D�teIssued ���/ r(�- 75 _ (�S�J7� . <br />