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<br /> &UILDIhG PESL'tIT APPLICATI0I1 �' ,•''� ••�E
<br /> � ' " j ' , , • • llpplicant To Cc:;,pletc Thi:. :orm � � . -'t '+
<br /> •�_'.
<br /> .r • � . • 1. .. ,� � . l�ry/.:: �.
<br /> , • • 2i aorc than one building is to bc contructed, submit a separatc permit applica- -
<br /> . : tioa for eaeh buildin3. .1 separate permit will be issucd for caeh t�uildinq.
<br /> � a �i -I '/ '
<br /> . ; � O�raer m � �, j'�/r�/�!y Buildinq Address ��`Yt�� •
<br /> .' - . �!'dzess 1��(Q C.(1 Qfy� Lot�� Slock a9� �
<br /> . City � hon�'i�:tL�.7� Subdibision (Plat) `�1 (��nrn � � �Q�, .
<br /> . � Architect gineer � • � ' '
<br /> •: � ''� City � Phone Metes i IIounds (Unplatted) •
<br /> � �;i•. Cmtractor 'yn�. Sec. 'hrp. Rgc , "
<br /> ,. ;. _�� E3d:ess�� •
<br /> .. Y City �4�i Phone � Bnildinq Use • '•� � �
<br /> 'Yi St.�te.License td�.-�ber �3 ��j%J�N R-E�Describe hiork to Be Done _
<br /> .F "
<br /> � • :. �1 Expiration Dat� o�- � - �� / c Xl i�r�O,M I �0 ^M�/l�a xJ �J-
<br /> �� ' " ' . • SKETCA PLOT PI.�li IIELOiP' • • UI`I�I7Y�Q� l� AIM/YYI�II_� �
<br /> � J•�� • . . � ' .. . . • • � , . .
<br /> Dce of Duilding
<br /> e• y � . ' . ' � . , , � ' �i7ew ❑ Addition �Repair/Remo::el
<br /> . . .;' ' . • ` 00
<br /> ` ;. . ' • , . � Valuation of Con�truction S �j7�.
<br /> . � .
<br /> ....,� � '� - . � . . , .. � � - � � PLOT PI.AN REQUZREIEYTS . . ' .
<br /> „ . . - -� . . ... � . . :.%
<br /> � . , . . . ,
<br /> � • • ' • � � - . � ' Inc'icate lot size, nar..e of streets,
<br /> •' � • .
<br /> . . '� • • " •indicate location ar.z wzd:h o� �
<br /> • ( - " i: : ' .. '.. • allcys, locate nropo_ed �r.d all
<br /> . • :-� � ' '� ' • ' existing buildiaqs, shaa distances
<br /> j ... - c- M : . � . �'� ' . . to property lines, show distances
<br /> s : • .� ' • . between buildings.
<br /> , . . � , Lot size x
<br /> , , ,- , . �.
<br /> ... . ' � • ' • . . Lot area Sq. C•t.
<br /> ' r. i . . . • ' � - . S'_ze of Bldg. So. Pt.
<br /> �i • . tiumbcr of Stories
<br /> , • :: . j� ' . . • ' ' Dasenent
<br /> r.. _ � -- �
<br /> '` •.:"� ' . 5�gned By
<br /> i_ • . . � • For - �l�.t-n���
<br /> � �, . • ncr Yhone -��
<br /> ., ' � DO NOT tiZ?TI: t3ELOh7 TitIS LI:7i-POR CITY USE 627L'1 ' _ �
<br /> . Date reccived � / ' f`' Uce� Zone , , �
<br /> ' - ��
<br /> ' Plan C:icc'- _7urSer ' ' Fire Zone '
<br /> Yaluation� �p���_ � Oecupancy Group
<br /> Pcrait Fce `y- �/ • �� Type oL Construction
<br /> Plan Check Fce Occupan� Load • _
<br /> ' c9 a
<br /> , ,� Rbtal £ec �ue �� Sprinklcrs Required . "'
<br /> . . Datc Ic�ucd � ' • • . . I
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<br /> • � . _ ' . •, ' , , ,
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