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<br /> � DY1LU1{Y4 CLItl'll'1' HYYLl�:/4'l1VN . . � ' ��
<br /> _- :• � �pplicant To Complete Thi3 =orm � / ��,j;��
<br /> • ' i! more than one buildinq i� to he contructed. submit a separate permit applica-
<br /> � tion far eac ,�u�dinq � A separate permit will bc issued for each buildinq. f���,�f
<br /> /y � �
<br /> - • p��r Huildinq Address y9�»���•
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<br /> � , lddress !��c :�.,.�� . Lot / !�,2/. slocx .
<br /> �ty f'�y..���� Phone ?i.Y. i�/93- s��vision (Plat) ��r.1.�.w..� .lU-r--,l.� •
<br /> ` • �rehitect/Engineer �'� � .f-o � �.•� � !�-c�c.....o.--.� �`'�. .
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<br /> `'� City __ '' Phone � Metes i Hounds (Unplatted)
<br /> - - . ._� ..
<br /> . .:�' Coatractor���irn �./�,�,�w-, Sec. �+P• R4e .
<br /> c , �ddress r.3 /7 �.�,..Z��, .�t..��.' .
<br /> �--- �
<br /> .i City �'.��,�1`' Phone ��2S .zI2 SnildinqOse �3�,,.��� � " ",:=��. _
<br /> ;' ' �''� Describe Work to He Done � .
<br /> �� �j State.License Number �� 3. /' �. �����5. _ '
<br /> ; • .1 LzPiration Dat� ��/� . �S "�� .✓� �/�I�-C�r.r.<� :��-�c . .
<br /> �� � '� • S10Ei'CH PLOT PLAN BELOW' • . �
<br /> ' � D�e of Building �� %i'� •
<br /> � ' ' � ' , ' , , . . . , . ' ❑Aev ❑ 1lddition LI Repair/Remoriel
<br /> ' ' . ' ' , • •Valnation of Construction 5 �/�/�•' .
<br /> . i . .
<br /> • � . � ' � - . � BLOT PLAN BEQUI?iF1`SENTS . �
<br /> �. � . .. _ � • .
<br /> s
<br /> • i! • �
<br /> ; Indicate lot size, nane of streets,
<br /> • � .; � . , 'indicate location and width of
<br /> ' j -,;j� � �s�"`�. � � alleys, locate nr000sed and all -
<br /> ' - u�� � �.' , existinq buildings, show distances
<br /> ' � ��,� , p _ ._ � . , . _ , to property lines, show distances
<br /> - • ' ; � - - between buildings.
<br /> , . '� . -
<br /> , .
<br /> � ^/} /� ! I : • yot size /: ' x
<br /> • ' � ` �, . I.ot area l�, s-,,. Sq. Ft.
<br /> ...- � ' - ' Size of Bldg. �r,,„ �. Sa. Ft. �
<br /> � r' - � Number of Storips
<br /> � _ _ . . '-L"r
<br /> ; •�
<br /> . ',; . ;� 3� . ,Basement
<br /> ... _ / _,
<br /> ,_ ...._" �� Signed .By
<br /> _ �
<br /> • '- ��' For
<br /> '� �' . � .� . � � � ,� Owner Phone
<br /> � � � DO NOT {r':tITL Bs:.Ot�l THIS LI:7E-20R CITY USa 027L'1
<br /> .. Da[e Ceceived Uce Zone
<br /> ' P1an C:�ec� :Jur.Ser Fire Zone
<br /> Valuation Occuoancy Grou� .
<br /> Pcmit Fee Type of Construction
<br /> , Plan Check Fee Occupant Load
<br /> , � ibtal Fee Due Sprinklers Required _
<br /> ' Datc Issued . I jn'•�/�j2Zl�� G�f.-�� .
<br /> • • • � Cl�
<br /> . � � ��.�,�l``�- : . .
<br /> . . -�/;:�i� � . .
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