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, � ! . '. , •. . ' 6IIILDING PEril1IT APPLICATION , ,�' � -. •� .( .`
<br /> _' • •• { • • : Applicant To Completc Thi� :orm • , ; �
<br /> . . � . • • . .
<br /> . • ' if oore than onc building is to be contructed, submit a separatc permit applica-
<br /> � . , tlon for each buildin3. �1 separate permit will bc i�,ued for cach building.
<br /> ' ' Orner � ���Q�l\� � �� 1��j�LC;,,; � riuildinq Address ���C�c� �`(�4:_'�� P� x,L�
<br /> �
<br /> � • ; Mdresa � � � � tot .'-j,�l V `� � Block c'�. '
<br /> • City � Phon � � �' Subdi�ision (Plat) ��{'L$r�. `1��4,_f�• .
<br /> � ; F;a:l , . .
<br /> _ • �tehitec�/Enqinecr � _� k�.
<br /> _ �ti :.. '_�i ctc�r �� • Phone Hetes i DOLnds (Unplatted) ' ^
<br /> ' � � � Sec. 1Mp. Rqe �
<br /> ;,• Contractor �
<br /> � .
<br /> �. ;• ..� Mdzess � . , , ,
<br /> 1\ �
<br /> 'f Mty�� Phone `Duildinq Use ' '.':_;�{'
<br /> ���71 � State Eicense Ncr�ber�-�L: -� 1`c�� Describe Work to De Done �` 'r
<br /> . . rr �7 ' .
<br /> � :• . 'I Ezplration Dat6 �,�I - / -`�,,� 1 hC� �,rY`_,1r� �0�� -
<br /> �.� ' " • • SRETCti PLOT PL,l7 IIELOtP' • � �
<br /> � r:�. :� • . ' • �• � •
<br /> � Ose of Buildinq
<br /> . .
<br /> �.� i ' _ ' . ' ' , ,,, �t7ew 0 Addition Repair/Remo5el
<br /> ' '3. . • � � . ' • • � �Valuation af Constructf.on $ /(„iC'Y1 ��
<br /> � . � ; .
<br /> ..,.. �� � - • • .-�. . _ .. � ... •� ^ � , , PLOT PLAN REQUI?2L•IENTS . ; : .
<br /> � . . . � . ��
<br /> ` � � � • • � • ' ZDdicate lot size, nane of streets,
<br /> • '� � . . � ' + ' • •indicate location and width o: �
<br /> . , � � • " �: : . '. j� • allcys, locatc nr000sed ar.d all ' •
<br /> . ;.'' ' • " ' . �. • existing buildings, sho:v distances
<br /> � _ ��� - � ,'.�.. �-• r- � : . ' . •.'.'• • . to property lines, show distances
<br /> � . � _ , betwecn buildings.
<br /> � . . _
<br /> . . , . • . • . Lot size x
<br /> . .
<br /> � � :.t- � . , • . ,� . Lot area Sq. Ft.
<br /> � �: � Si2e �f II1 g. Sq. Ft.
<br /> �f �' � • . Number of Stanes--
<br /> . ;; _��' ' . • ' Dasement
<br /> ��:. , ' .
<br /> •� ,�:.� Sig9ed-8y�
<br /> /
<br /> y: . . _ � Fbr _ \�l 4���
<br /> , �
<br /> wncr Yhone
<br /> ' � � DO NOT lti:iITS BELOI] TIfI.S LI:1F.-?OR CITY USE OiIT.'L � _� -
<br /> Datc �eceived � IItts Zone • .
<br /> ' Plaa C:�ec:: :Iur..ber � � Firc 2one ' _
<br /> Vnluation •�� �,C'� . �� Occuoancy Crou� !_
<br /> Pemit Fce ���- �t Type of Cor,struction _
<br /> Plan Check Fee Occup�nt Load •
<br /> , � 'ibtal Fce Duc _ Eprinklcr� Requlred �
<br /> ,. . . . .
<br /> Datc Issucd , . . -
<br /> ' ' . ' , . : . . .
<br /> • . • . , .
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