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<br /> - • •� 3 • � • Applicant�To�Coc�pleteyThi:. =orm ; .� "
<br /> _ • ; • : • . r
<br /> ' • ' Sf more than one buildinq is to be contructed, submit a se��arate permit applica-
<br /> � . : tlon for eaeh buildin3. .1 separate permit will be issued Sor eaeh building. .
<br /> � " � Orner �E SNAC�E�'�� Buildinq Address � �.��,; � � -
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<br /> � � . � 7ddzess ��7,�5 �('���� �`�Li� Lot ' S / Bloek ,�.?S .
<br /> � . f .
<br /> '. , City �(,E�E� phone Subdi4ision (Plat) p/t} T O t • .
<br /> ` J�schitect/Enqineer � ' Fi 7r.�e� • � ' • � .
<br /> _ . .
<br /> _ !t : . ":� City Phone Hetes i Dounds (Unplatted) ' •
<br /> • ' j' CO�LLdctOL SFh}TTLr T N�' 9' �L���/NY ' SCC. '1Y0�. � RQ0 . . • `
<br /> ' ';, • �. aaar�ss 9m ,c�. i37� �—T . • .
<br /> . •r • • • ~ �':.
<br /> City S'e�77LE Phone �.� Snildinq Use :"': �� ,
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<br /> -• � "; Statc,LScense Ni:.-cber �73-n,?— .33�� �scribe Work to Be .Done����*�
<br /> . r.t Expiration Dat� " /�.c�'/'/iiir/1I+ � .� -f��i<�i�'!. (T /� •
<br /> .: .. ' /� / �) , ,� (� .
<br /> � L�: '• ' • S1CF.TCH PLOT PI.A?t BELOi4' • •S�n�INaP� � ��/Li.(//� /'. f-t�. .
<br /> + • +� •• i • � Ose oE suildisiq /,'��%�_ � �
<br /> . : .�� ..:�.., �-�:Ju�: •�. � - .
<br /> �.� ; , , , •: , ;;, �New �,Addition ❑ Repair xeaoGel
<br /> ' ' -'�, ' '^�^:�wt'� ti�' •1.' , ' . .�• . ' �Valuation of Con�truction S��t � ' '
<br /> =�.�_. . j� c 3�h�'1,'
<br /> .�• ' •. � • '�.' . f' �. YLOT PLAN REQUI?tE�tEYTS - � .
<br /> "."'-' . � .. ' ` :��:1/.�'�%Gt� c... .:����� . . ' : ,.? '
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<br /> :, � . � •-,L-� ';�� �,-, -• /� � ' Zndicate lot size, na1�e of st�eets, -
<br /> _ - . • • --e��-�i ,�uCCG(/j +�� � ' •in8icate location and wid:h o� � -
<br /> ,�. ' ' � - . - i:: I s�;:• • alleys, locate pr000sed ar.d all
<br /> _ . ;.� � ' a�•f ��.,� '' cxisting bnildi:gs, sho:+ distances
<br /> : y . . • � �� ,� - � .� . , , a • . . to property lines, show distances
<br /> . , � : • � , y , ••�' - . betacen buildings. . �
<br /> • � � � Lot size x �
<br /> .' • � `;.i=� ! C• . '. � . . . • • L, ��, - � Lot area ' Sq. Ft.
<br /> - � �: •.•. • � Sizc of B1Cq. Sq. Ft.
<br /> .
<br /> . . •i � � � . . • . • liumber of Stories
<br /> . •: • . ..
<br /> , • . ;� .i• • . , ., • Basement
<br /> r..:�, . . . • . ' • ,,�¢�' . �. �Qtt� � .
<br /> '�•�. . ' . " . . ', . • Signed Sy .� ..r./ !�>a*';+��
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<br /> ..1' . � • . � �•• . For _( ri. .s.vrn�'i'/G .
<br /> - _ �� . Owner �? ne
<br /> ., • DO :10T t<7IT� E�LOtfi THIS LI:7E-POR CITY USc�0i7L'1 � �
<br /> . Date Seceived � � Ote• 2one ' , �
<br /> . . - . .
<br /> ' • Plaa Cheek :7ucber ' ' Fire Zonh '
<br /> �• Yaluation ���� • �� �� Occuoancy Grov�
<br /> � Femit Fee �r� �� ' ' Type of Construction � '
<br /> . �,
<br /> .' Plan Check Fee � Occupant Load �
<br /> (�'� � , �-
<br /> • • VV 4
<br /> , •,� Sbtal Fce buc � � Sprinkl�.-s Aequired ' , �:y
<br /> � .. • Date Issucd . • . �' j, , , �`, • ,. . , ' , �� lt
<br /> t � . • ... ' . • . • • • U�J�����' ~�'�' ' , ' �1w
<br /> � • • , • • , • � � , ' '���/�� • , , • . . ` ~ ,. .
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