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<br /> , ., � , � LOILDING PERMIT APpLICATION � '
<br /> -- � � • . . .t i
<br /> . , llpplicant To Complete This ^orm ��'C'•`;j
<br /> , • � 2! more than one buildinq is to he contructed, submit a separate / /f f. • '
<br /> • • tion for each buildin �("�- ��
<br /> �• .1 separate permit will be issued for eachebuildin�llca-
<br /> . � �•Owaer ���1 ? Q:La��n, � C^ )�( � � , • �
<br /> � << �� ��.�'���„� Building Address _;�._ ��/�`
<br /> ), {` �,�1.c.-_—
<br /> , . �dIC59 �=� (.'��� C,�.i-2. � �- , . ..
<br /> � l.` . L� I . LOt BIOCIC
<br /> CSty �ue-...-;,-(- phone �) 5=/ `I %
<br /> 3 Subdivision (Plat) •
<br /> , � • Urchitect/Engineer � '
<br /> ' :..I • .
<br /> _ _ .i City —�pk��� _--- Hetes i Bounds (Unplatted)
<br /> ; :� Contractor ( _iti�n�,_o.� (t��.�, � Q ,
<br /> Sec. �. Rg
<br /> .. �J � e .
<br /> _ � '_ bddress � � I 1 5 . .�- . �P . . ---__..
<br /> '_ City _1 ,_`_� phone r�)��� / Z guilding Use . �
<br /> " ,
<br /> ' ��� � Stnte License Nur,�er � . ^ °'�
<br /> . �• . • Describe Wurk to Be Done ' ,'':- �
<br /> .1 : �i Expiration DatB ' `��Ll�-�-._a��� � �ti. � , C`C— °�� .
<br /> . Mtl--r_-�
<br /> . � , ' SRETCH PLOT PLAN BELOW' . �"Y7:CL,Y�p C`G�y�fIL�� C���,�i i'.� .
<br /> � . ' . � ' .. . .. . - / � - .
<br /> ; { . • Os�e of Puilding �0���,�� •
<br /> ,. • . . . . '. ` ', /: l� .
<br /> . , " ' • . . ONew ❑ Addition �epair/Remo:<el
<br /> .. i „ . : I
<br /> � " � ' � � � � Valuation of Construction $1�-r'IQ �j
<br /> � , . .
<br /> •.,,,. . .. � . . . .
<br /> � � . . . . . , � � � . . PIAT PL7�N REQUIB&�IENTS � .
<br /> , . � . . . • • . -
<br /> � � � ' Eadicate lot size, name of streets, . �
<br /> • . ! • , ' ' ' ' � indicate location and width of
<br /> . ' ,•_j ' •' ' . : alleys, locate pr000sed and all �
<br /> • I - • - ._ ,� ^'�. existing buildi:gs, sho:o distances
<br /> , � � • ', • to prooerty lines, show distances
<br /> � � . _ betveen buildings.
<br /> ' ...- � ' . Lot size X �
<br /> . � Lot area Sq. Ft.
<br /> ' ��� ' Size of Hldq.
<br /> � ' ' Number of Staries-- $Q' Ft.
<br /> • ��! � I
<br /> �••,__ _ • ' Hasement
<br /> ��\�
<br /> ,� ,� .,
<br /> . � Signed By 1� �� !��,(�� � ! �/li� ; ,-�
<br /> � � � For � II � � � � '
<br /> o , C��� , .
<br /> • �. --Owner ; Phone ,
<br /> ��
<br /> �, DO �OT Ii:iT_T� 3ELOh7 THIS LINE-POR CITY USH OiiL'1
<br /> Date S�ceived ' '
<br /> - - Uce Zone
<br /> ' Plan C:zec:; ;:ur.,Ser • '
<br /> Fire Zone - -
<br /> Valuation •
<br /> . Occunancy Grou,�
<br /> Pemit Fee Type of Construction
<br /> —�_
<br /> Plan Check Fee •
<br /> , . Occupant Load
<br /> . � Total Fee �ue •
<br /> • SprinY.lers Required
<br /> Date issued - .
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