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� � { , , . • : ouaa.ua�•�, rc�ia „rrLi�.ny�lVrv ..
<br /> � � � �plicant To Completc This :'orm ' � ± �
<br /> r . ' . � `, ' . ' / ' .�.
<br /> � .. • � 2f more than one buildiaq ie to be contructed, submit a aeparate permit '�p��
<br /> . •• . tion for each buil3i�q. 1► separate permit will bc issucd f /�� "p1���
<br /> •� or cach buildinq.
<br /> • ; � Ovaer �� ,�,� /�� ., � �c !�� o .+ , Huildin Addresn � R a
<br /> : . ; � ---_....� tiC 4 _ y 1, G� . -/�..�.i� '
<br /> . + iedresa �jNoz ' cl,z�4 L�t,,,n a,vG Lot_/ 'J- �$- /Y Hlock
<br /> . ., .—.S' 3 1. - 0 ci�. .
<br /> .��.�• '� � �tY �d�..!a /7 Phonc ,LJ.L �ZCl/.P Subdipision (Plat) �cLo,.:. 3 /Aqe� . '
<br /> ' � ' �iehlteci/Enqincer S�� F � ►, I
<br /> . . � '..�. - I�\ IZC�r._ r � A_ � 1 Pr Cp ' I,S-t'
<br /> _'1�:,°Jt City • Phone ltetes z Bounds (Unplatted)� � •
<br /> ' :.' Contractor " ' S {L, p . ' Sec. � �
<br /> ' �-%' '.�' 3ddzess S'o ,.. � . '. . �• • �e � ,
<br /> � •�, •i _ �
<br /> � CitY Phone o�.:�.� • . �
<br /> '�" Hnilding Use ;L- GA ic /✓��e j`r •': ' F^!
<br /> � ": .�� .'`:` . . '''`'":
<br /> ' '; y btite,Li cense Niacber — ' Describe Work to Be Dona • ,�'��t �
<br /> . . , � f'uT Av
<br /> ; . ;�II �pisation Dat� "' + ' Fe e i�..., ^ f ' .r ..r f L e � r � �( ' :
<br /> 1: � tey.7
<br /> � • � • SICETCF! PLOT PLAN BELOW' V_P M �SlL� t`'�y" jo7lrS /- ren/h " �
<br /> .�; � •
<br /> • :� . '- -�-'F �.� + Q�a of Buildin4 G�4R On�tT ; .
<br /> .
<br /> ;~- , jY S,E: • • . .: • . _, : — .
<br /> , .� � c, ��,� . . =.5...�.�.= . '�Hew ❑ Addition Q Repair/Remociel
<br /> :• . i. :
<br /> ' • � - � � • 'f � �D`�� �Valnation of Constructien S �Z�'�"`
<br /> i • . • � '• � �� . � � �
<br /> -_+ � .. . •p ..�• - ' ' � • � pLOT PLAN REQUIREt�LNTS ' : � .
<br /> �.' .
<br /> . . .• . ' ��' _' � . • � '.�
<br /> . ' ,� � • , .".'... � 3 ' ' ' , ' � ' Sndicate lot size, nane of streets, � '
<br /> � . � ' •indicate location and widt'. of
<br /> � '� N ' . , ,�i. �: , •� '�.�� ,: 1;.:: : • alleys, locate proposed and all �
<br /> �� ,• � "•' 1._ ,�� - -- . I�i- '+r ' �. • existing buildir.qs, shoiv distances �
<br /> ' i.�i � "'�' =� • � F' �•" ���T'6" -' � to property lines, show distances
<br /> • �, j yv^^j5 . ! . l �,� ;:.1 ��J,. between buildings.
<br /> ' � � • �� 0 .0� ' ( .
<br /> ' • :'. �. , r! • yL�, � �� { ( - 7s.h. ' ��( ' �I.ot size 17 ,5"� x / �i o � � � . .
<br /> :t- �-� � o _J..: y '( P;,
<br /> ' j (�I.' ' � fi R ( � � , � . Zot azea Sq. Ft.
<br /> ' �.. � �l �� c n �:� ..� ,' �,ISl�� �/ SSxe OE b 4• : , u , t Sq. Ft.
<br /> �:�-•.. • k+ c • • . �'ri o l�lu:nber of Stories
<br /> . :. 1� '• �. i • �a„/ +�
<br /> . i:.. . 1 ' `���;. ":T1 �� `S'* �Sasement __ ni o ,v �,
<br /> +..i:' T �', .. . ..� . �f ' p'E _-,- '
<br /> _ 1 C�„N; •'!�` ' ;. � • '' ' 2 - igned By
<br /> 1
<br /> � . �
<br /> � �' ��--` For
<br /> . . �� �. o .s�� -—c C.....T Q� , Owner Phone — . �
<br /> _�� � � � DO NOT h^,1IT5 AELOFI THIS LSNE-i OR GITY USE ONL'f ' - � •
<br /> , ' ..' Date �eceived < /� �� Dce Zon� � � `
<br /> . ' , P1an.Check :Iur.ber 7� 'Z?� Fire 2onc 3 •
<br /> ; ' ' Valnation �__LZ.�Q�� E� pccuoancy Group f -� '
<br /> , • temit' Fce �2 _' yype of Construction v - �� , •
<br /> , ' Plen Check Fee —� • ' OccupanE Load • •
<br /> ;? 'I'otal Fee Duc _� b�zinkler� Required ' .
<br /> � Date Ic ed ' /J� S`' '� ' C.ITY Ok E�(1=.RETT • , � •
<br /> t y�� �� 71i „ . . . .•.�':� APPROVGD;FOR F3t111,liING PGRMI:T� �
<br /> .'��(X%rxti� , . , . � 1• . • • , .
<br /> , • � ; � . . . ' : . ' :. � . : ' �,r�_a,.l.��.f;��:, � _�,s � .
<br /> . . . . , , - .- y - . t_—�.'
<br /> - . . .. . . . . • . ' •�J
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