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BUiLDING PERMIT ppp71CATION <br />Applieant To Complete Thia Form <br />It more tban one bnildiag ie to be aon�tructed, subv�it a aeparate permi! <br />appllcation fot each building. A eeparate permit will be iasaed tor cach <br />bttildiag. <br />3�3,'s'' <br />Oweer !�IY. �"r¢, IA �1 Sfw :, e V Bnildfag Addres�__,��'� �c %� ' <br />Addre�• _�:) � �t f �,'y Lotz�iT','��Slock � � 7� � . <br />Cilp �4 t;)^C�- Phone�i�`�-yl�G Sabdivi�ion (Ylal) �1 �czcd' V �.2• �-l� �irr a� ��}�'� <br />Arehittet/Eagineer � ' <br />Cltp__ Phone Metea k Houads (Uaplatted) . � <br />r � . <br />Coekrwclor_{I r�vl. I/n�' N tpit; See.�'rwp.��nge <br />Addro�n c �i7 �,��t`•�i� Y' � L% <br />Cltp �'t�tY�Y_: 5�'�/�f%r Phone�5y'J�L�v'rGHvilding Use_ �lr".c_, �S onYs't <br />Stale.I.irenae Num6er�.3`4i-'%5 j'3 Deseribe Work ko be Done � <br />1'spiraHnn Datn <br />SKETCFT PLOT PLAN B�LOW <br />'iT�e• of Buiid �� � �� hTi h.e <br />�- . „�. Nem Addtkion �Repatr/Remodel <br />�2,[.,L C�`<-� <br />- .—:. . � <br />.� � <br />GdGl3v <br />i <br />ValnaHon of Conetruetim s S/�'J`"- <br />PLOT PLAN FtEQlTIR2:M2�;NT5 <br />Indfeale icF eize, na.me of atreeta, <br />ind[ute �oi:aHon and width of alleys, <br />- looate propoeed and a11 exiating - <br />buildiage, sTiow diamncea to prop. <br />eztp lines, ahow distaaeee betweea <br />. buildinga. <br />Lot �Yse '� � �� x / � r� <br />Lot area"–�=:r � S . Ft. <br />. 4 <br />Stte oE Hldg. Sq. Ft. <br />Nnmber of atories <br />� ' • Sa�emeat�— :7 � � - <br />t. � . . !/ , � � ,ky,I"�„/,.,/ ) <br />- Si�Ded H� . ' ~ Dit! ._;l/Y /,^'�,Jl <br />r'_'*� <br />' �"Of :Jsf . , y�.� � � : — . <br />. �O�ve�er Phohe —�-, ,�QC���� <br />gELOW THIS LTNF. _ Fnu rr�rv ncx� nnrrv <br />»ace ttete���a 3 /r¢/'�� Vre Zonn �/ � �t.�v � �j[* <br />f� - ,_�P <br />Al�n Check Number 't` – 14L FYre zone �3 � <br />ValuxEion_ ---- l.. i�..�p .,_.., Ckcupaacy Group I <br />Pettnit F'ee ' 3� . J-� Type oC Conettuctibn 11_ i�� <br />P/Ytt Check Fee_ � Q� ;� Oceupant Load <br />Total Fee Due 5 q., J't� Sprinkicrs ltequf e �. �.y <br />Date,is�ued . 'f' � �/ ' � <br />