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i <br />� <br /> •.. � � HUILDING PERMIT APPLICATION � ����� <br /> Applicant To Conplete This ^•orm <br /> ' If more than one building is to be contructed, submit a separate permit applicaF 7� <br /> tion for each building. A separate permit will be issued for each building. <br /> _ �e1 — •��.�C�V C.'���:(� Huildinq Address � 7 <br /> _i <br /> , Address Let .��!- (o Block <br /> City �t�yrpr�phon ��j'�._/375 Subdivision (Plat) <br /> � Architect/Engineer _ �=/���tr�'�h� �F <br /> � <br /> C.ity Phone Metes 6 Bounds (Unplatted) <br /> � � Contractor /��.��/j'j [`; ��'//��' Sec. '1Wp. Rge � <br /> , �Vi�ress (O�/ BROAlJ4/�41i <br /> ���p�j'j" Phone ��"{-/3�'•S� Building Use /� iSrSENT_ <br /> • � u►a�r. <br /> cense Number Describe Work to Be Done <br /> ��� x�fifation D3;�e � <br /> l� �� <br /> ' �J S CH PL � L}1N HELOW' • - <br /> • � ���..,/ � -�� � Ose of Buildinq /r�.+.�..�.%o �.�„r.� . <br /> � �� � �1New ❑ Addition ❑ Repair/Remodel <br /> . : C � , ::Valuation of Construction $ _ <br /> � _. �. <br /> _•�..-._—__ ''r 1''r I' t;VI��F '- . � . <br /> Y "'.P. ��.PIAT PLAN REQUZHEMENTS <br /> , � �f � . -� �-��i�.� . , i <br /> ^ � Y`3 `•, ,_ , � ., � <br /> •- � - •�'Q. � " Indicate lot size, name of stre�ts, <br /> � /�c,a;' �,�� � � indicate location and width of <br /> , ' ; G��1::"�f'- �, alleys, locate proposed and all <br /> . I i ._..�, ' js.,. <br /> existi.ng buildings, show distances <br /> --•-��JP �, '� � � 3���. '� � �� • �. � � to property lines, show distances <br /> ' '�r Z'7 �' � � ♦ ' L�l (.fi 0 . • !:�� between boildings. <br /> , � � I <br /> , . f � _ : , Lot size !�o� x /lbw <br /> •� � ,� Lot area �i�fJ0 Sq. Ft. <br /> • • Size of Bldg. ,3r����•�� Sq. Ft. <br /> � Number of SL-ories ,� <br /> ,.. • � � � <br /> - �: --- j � .�� �_.,j, ;JBasement /y,p <br />�' �,,,°•.. 9` u ^r.:1'::,f,._.�i-. � r,1 =.;. :' '� I , ' n _.� <br /> " Siyntd BY ���lti� I� fdt,�Q'e <br /> �-�: `�` I <br /> � �l F.�cpr- �N'�M t� For <br /> � �N �. Owner Phone • 5�S � �3 7t <br /> ��Z'��sL 'i'q�E�.�fj. ►y.A�ll1; <br /> � �T• I�'l PF�•�H9•\C��•.��L IIEi0l9 :H2S iI:7E-FOR CITY USE O[]LY <br /> l <br /> � ate ::�ce�e3'�7�,�Q -7 S � Uce �or.e �"�= MIAGt1�tpM. M�{rFl � <br /> 'rlan Chec}: 2�uri;er Fire Zone � � ' <br /> Valua=ion Occuaancy Grouo <br /> Pemit Fee Type of Construction <br /> , Plan Checl; Fee Occupant Load <br /> Tatal Fee Due Sprinklers Required <br /> � Datc Issucd � � <br /> �. l%QJ�CC�.�'if� �-'LQ' 7'S $1'D� `f L1A�5• h�l l N O�b� S� 'i'NI {�,. <br /> �T '?ats�a. M�M a� � �� <br /> . <br /> I <br /> k <br /> I <br />` <br />