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<br /> BUILDI'7G PES2MIT APPLICATION , /% 7�/� •�j �
<br /> Applicant To Complete Tnis Sorm � 7��/s
<br /> If more than one building is to be contructed, submit a separate permit applica-
<br /> tion for each building. . A serparate permit :�ill be issued for each builQinq. �
<br /> 1 /� � J �J � . 5i9a3 ' f=v.c.j � <.�. e</)��
<br /> Owner C u 7 � (_ 4 r v K Buildinq Address 73,� /yJ. S�i��f� ,.*�(�-�� Tj�'
<br /> � Address y�J O ;3 �J� Y�, r�1�� Lot � ,/ y Block
<br /> i
<br /> City �✓, Phone�S'�^/,�l1 / Subdivision (Plat)
<br /> Architect/Engineer .l ry �C�A ��i�� ��i1 d� �4ii^
<br /> City Phone Metes 6 Bounds (Unplatted)
<br /> Contractor �r�L� �—� N 1�� c� Sec. Twp. Rge
<br /> Address �,S"'3 i hc�:-i-c r�
<br /> City �,/ Phone dS 3- yG s� Building Use iD vn.�✓ � r3 � '�
<br /> State Licenae Number 113-G/- 7 3� 7— Describe Work to Be Done r � �n n '
<br /> Expiration Date � .. �7 i c r n ih 5 Z +Y4 �.�.� r .�? F-D �-s• ht. �p
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<br /> SRETCH PLOT PLA:1 BELOW 7A�.p S'./J,�7CL • -
<br /> , �-,.,; f.,:y ' • ' / •
<br /> ��, Use of Building �ra.� T-�, s��) �r�.�
<br /> — . i
<br /> �I • New ❑ AddiY.ion � Repair/Remodel
<br /> �XY "'J � �= -
<br /> .T� i aluation of Construction $ ,2�'bd
<br /> ur ` Y+ � J_J�S'rc(bu�yT PLOT PL11N REQUIREbSG:7TS :
<br /> ��� � } .
<br /> S � Sta+� �X�' �"y /�-����, .5'�Cv{, indicate lot size, name of streets,
<br /> ��'� � .$-�/0 4t . indicate location and width of
<br /> alleys, locate proposed and all
<br /> f��3 existing buildings, show distances
<br /> e �'� to property lines, show distances
<br /> ���,. ��`,y w�j���_��rrK� between buildings. ,
<br /> S' k 1 �'
<br /> �Ur�� ��� Lot size x
<br /> �, ' i _� TJ,i k r Lot area Sq. Ft. I
<br /> t i Size of Bl.dq. Sq. Ft. �
<br /> './� / j. / � � /�aJ,`�rcn i � Number of Stories ' '
<br /> dd : �1'eu�73 i l{c oC/rt p � �
<br /> r ase.^..c^t ,
<br /> ' F���. � �yiP^�x �r� � w. ��. rt r1. ,�. . . 0 ;
<br /> S�)c' l'
<br /> �jr�J �� n�P.f� i rY �f � VtS:n�r i�. nrJ igned By ��,L �`�. � ` .
<br /> ,=��'Y r � - - - - -� 1 �.�. -��r w �
<br /> t oz
<br /> � J'��o' Y-z- Owner Phone '
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<br /> i � DO NOT WRITE 3°LOIJ THIS LI:7c-FOR CITY USE O;ILY j
<br /> � �
<br /> ! �.-c =,.;..�,., i j�_ �� U� e zone - —
<br /> � �!an ,...ec: )�cr=cr Fire Zone � _ �
<br /> Valuation 2S�• E� Occuoancy Group �
<br /> I � Penait Fee ���� �'-, Type of Construction � �
<br /> Plan Checl: Fee Occupant Load
<br /> ITota1 Fee Due �f`� � Sprinklers Requized �) �
<br /> f � f / t � �`.
<br /> - � Datc Issucd � /5� 75 , , . . ' . . ..
<br /> � �- .�. '� � � _P,� � � � -
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