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<br /> . , '� • — �• • ' IIUSLDII:G 1'fRt�SIT APPLIC71TT017 . , �y � � ,�*j
<br /> — .. ; . : ApplicanL- To CompleCc Thi� 'lorm . , �� � �-'�T
<br /> / ' l �
<br />' .. . ' If norc than onc bui7,dinq i� to b^ contructcd, submit n .^.eparatc pernit a��ca/�7
<br /> � uqn for r�ch buildi::3. .l seParate permit will bc isaued for each Luildi��y. ,
<br /> ' ' 6+uer �� lA���,r�� � /-��� �_ Duildinq A�dress � �.n �� Ce,�b��. :
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<br /> � ' . Address �(���,��v�� Zot�(a Dlock `��.� :
<br /> � City F��e r�f� . Phonc�s �=_3.�5^3 3ubdivS.sion (Plat) F �-�,r e1� . '
<br /> ' � ' ,(� f S� l
<br /> - ' • Erchitcct/Engiuccr _ �c1`� �Sl� � �
<br /> •: '"� City Phone I3etes & L'ound� (Unplatted)
<br /> - - . � i ' . . ..
<br /> ' � Contractor �ec. Ztu�. Rqe
<br /> . ;,' . .
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<br /> _ ,. . � �3�rc>c ,
<br /> - - ,
<br /> ' -�ty Phone 'Huildinq Use '- — _. -- -
<br /> _ :_�}; . ,:. . . . . ;.. , :
<br /> '"' � Stzte License t7L:..ber Describe t7orY, to IIe Done
<br /> �'� .
<br /> . . r. . - �' {,Gr�
<br /> - . Expiration Datt � ' -��tS�n�� ' W�Yt-' ? � Q'S-�
<br /> �1: " � .. ST'.I:TCIi PI:Oi PL::i flrLOS.I• • • ��� t'rU�eL�O✓� ; ..
<br /> " : . ..�� � . � .nse of. Building ' _. �
<br /> �, ' "� • , • ." . . : �hew ❑ Acldition ❑ Rcpair/Remo::el
<br /> - . �;' : . - i� . . . ..
<br /> ' �• - ' • � '' • ,� , � , � . - Faluation of Construction $
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<br /> e : . � _� . . :BLOT PLtsti R2:QUZ?t�;:.ITS . •
<br /> .= + �� , . . . � � � � ,
<br /> . ; . , : • . • ' Indicrit-e lot nize, nar..e of: street�,
<br /> . .• .; , = . _ �.�� • •indicatc location and wzcth o`
<br /> j , •- .. , � alleps� 'locate aroposed ar.d all •
<br /> � � • � � � ' er.i�ting buildi:cs, she:a di�t�nces
<br /> . ._ j .
<br /> j , . ' _ ._ .4 . . • +�_ . . tu prope:ty lines, show 8istanees
<br /> , � . e , . . bettaeen. buildings. _ ,
<br /> : ' . . , y,�t: sizc x '
<br /> , , • .
<br /> � . T,ot area Sq. Pt.
<br /> � � '� � ' �. . . � 3ize uf IIldg. Sa. Pt.
<br /> ` r•• ' ilwabcr oL Storir:s
<br /> • � t • . -
<br /> .� - IIascaent __
<br /> r� � a. Si�ncd By ��S ���-,-� nr/� �.�� 1 ���_i� `
<br /> 1 � •
<br /> • . . . . . T•or � ---
<br /> ' ' . ' � ' ' • Ciwncr PLonc _
<br /> � • � DO :dfl.' k:t?T5 :3ELD'.7 Tt1I5 T.I;7i:-rf12 CI7'Y US?: O,Il,'1 _ `
<br /> Datc `.:eccived J - � � I `_ U�e Zone ...
<br /> ' Plan C:�ec3: ::ur.,bcr ' ' Pirc Zonc - —.,
<br /> Valuation � Occunnncy Group
<br /> � rc:tii�: r�� � Zy�c df Con,truCtion _
<br /> Plcn checl; L•'cc � OceuP^nL I�oad
<br /> iotal Pce Uue , Sprinl:lcr� R,:quirr_3 � __ .
<br /> ' . ' b:tc I.^.cucd _ _ ._. .� � JG+r�'�`t� ' , . ,
<br /> '. ' , ' . . � • • ' � �/L�,�i��_ '�
<br /> . . _ • �� ., �.
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