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� • .'���_'... " `.""�"'_ _""' """ /(� 6) '�/ <br /> - / <br /> � If more thae onc buitdin� is to bc ron�trvated, nubmit a separatc permfi ,�/j�/ _ <br /> ' applitat:en fcr r.+.�}� bu:i�]ing. A eepasate peimit v.:fl br in+u:�d [rr eac � .. <br /> . building. <br /> Owner CN A 2l-L'S F� �C � ? n <br /> 'X-Z�IIuildir.g Addreu_ '�-:C� `i��j�� <br /> _�t+ C'.C'LhY <br /> Address - TT Lot'��"�Block 'ZZ � 7— -� <br /> CitYr[/!'r'�%% Phone S -si^ Subdivieioa (Platl.�t!G-N% S /jC/,� <br /> �� � ✓[-T_� f <br /> l+rchitect/Engineer y :�i �+t�. � ��,,,y. c� <br /> City Phone Mettn & $ounda �Uaplaltedl � <br /> Con:ractor� ' f' � '. . .. <br /> _, ti��'7__$ Sec._Twp.__�nge <br /> Addreee �'.�_ L�i j � ••�' ,['.> . <br /> CityC1� •.S;f- _ztA�S' �[�han �` -S;= Bullding Uee._ ��A,{'�;i� <br /> State License Numbaa��3 CI ���7 Deacribe 1Vork to be Done <br /> - E�piraiion Date �� � � 7 / '�S <br /> 5!'.F:':Cii i': � i�;.A'; �ttLLG� <br /> Use of Builo�ng <br /> j�New []Addition �Repair/Remodel <br /> Vaivation ot Conetruction 5 " � <br /> �"l� 'I' PLOT PLAN KEQUIliEbSEtiTS <br /> I - indicate ]et size, namr of etreete, <br /> �} � n t <br /> L= ' indicate lu.alion and x-idll. vf allcy�, <br /> f � � Iocate propoeed and all exleting <br /> f�� buildinge, show� dia:ancee to p:op- <br /> � � �-� crty tinen, ahow• dietancee betu•cen <br /> �1 � � buildings. <br /> �\\\ Lot sizc �7`'� x /5 G. <br /> JLot area Sq. Ft, <br /> Size of Dldg, �•ti�C S Ft, <br /> 4• <br /> . Numbcr of etoriee � <br /> Saeement <br /> 7 '/ <br /> Signed Dp�j,(�c.,.�J�. /�'1-lc -�_Date �7 , <br /> � For � <br /> Owner Phone <br /> DO NOT WRiTE AELOtV THIS L1i�TE - FOR CtTY USE ONLY � <br /> .�- Date Received Uee Zone � <br />� Plan Check Number_ 11 ' I �- 1� Fiie Zone 3 <br /> to <br /> Valualion t.,ZqJ, `� OccupancyGroup � <br /> Pcrmit Fee q-�7, �..a Type of Conetruction � N I <br /> Plan Check Fee ?� „b Oceupant Load <br /> Total Fee Due �o , J-t) Sprinklcrs tic�60V[D FOR �UILDING PERMIT � <br /> Date Ineucd ` <br /> Dale�L��ti g/ .� L' • <br /> F <br />