|
_ - i " ' ' DOZLDIIJG PEFtHIT APPLICATZON , � � '� t
<br /> ,.'•• ...,T
<br /> - •' � ' , , : 1lpplicant To Complctc This 5orm . . •,..,,i_ :
<br /> .. . i . . . .
<br /> ,� • • ' I! morc than onc buildinq is to bc contructed, submit a separatc permit applica- ,
<br /> : . , tlon for each huildin�. A scparate p�:rmit vill be issued for cact� building.
<br /> • ;�t ' 2�l�t ' ,S'
<br /> Gvie'r ���� C,rF=a IIuildinq Aldress �(�J ;�'�%�'1 j-ur,. _'��'+ �
<br /> ' • �ddsess • Y
<br /> , , ,�1 nn �uc,� . ,-._W�_ Lo�c IIlock
<br /> City ��/p rP� P one ` Subdi4ision (Plat) • ,
<br /> ' • llrchitect/Enqineer • • � • ' •
<br /> _ •: � :':j City � Phone Hetes c Bounds (Unplatted) ' •
<br /> . i ,/ I_ { . • -
<br /> - . :�'. Contractor y j,S 4'� �+� Y ' 0� S_ Sec. _ 1trp, Rqe .
<br /> ., • ;." '_;' address �/7 D D 4t?�c� iid.cti �{.�;• . ,
<br /> , • �
<br /> �. �'i: ctty F� Phone �5�.. 337� Building Use � F�=i � e ' � =r ` .:
<br /> ��i . . •.,:, �+ - � • . '.. : _£',:,.;..
<br /> � �'�� State.Licer.se Ncraber �,� 3 •L� `�y y7_ Desctibe WorY, to Be .Done 1iiti.�.d.d. 1't� I"F
<br /> � I .
<br /> • , 'I E:piration Date 0 3 --0� ' : fn ' ''��'i-�.P ' � {�n.�� �r � vn-s� �
<br /> ,i: . . . • V! • / _
<br /> SKETCH PLOi PLA7 BELOS4� •
<br /> •� J '� . . . ' .. . . . , : , • . , .
<br /> IIse of Buildirig D,��_p
<br /> • iT
<br /> a•. � • , � � - � � , �� • ONew �Addition ❑ Repair./Remo::el
<br /> . ,, ,;' , ' "' .�;.... ' . � '
<br /> ' ;• � ' ' " � . . • i' '• Valuation of Construction $ /_�`J� � A 4' •
<br /> . � � �:� � � • PIAT PLAN REQUI�E�L:]TS .� .
<br /> �. . } - . � :� . .. _ � , :
<br /> �v . , , •
<br /> � •�'•. � � , � • . .� . . .
<br /> ' � • ' ' ' ' ' • ' Indicate lot size, nanc of streets,
<br /> . . j . ; : • . � .
<br /> • • . .. '� .� ,'.: . ' • ' �indicate location anfl width of �
<br /> , : ^ , �; �•.••'= allcys, locate proposed aad all .
<br /> . . � -=•••�--c. • .
<br /> � , existing buildings, shc:a distances
<br /> , i ' '- '! � ' ' • . to ro erty lines, show distances
<br /> , � ; : ' ���� � .� /� - , betwecn buildings. .
<br /> . . � . �.�I �O. %' � . "' � . � � . "
<br /> . .� : ; , . • . . . Lot size x
<br /> , .
<br /> ..:- i . . � `� •' ' �. � . Lot arca ' Sq. Ft.
<br /> • r. _. �. i^ � � Sizc of Bldg. Sc. Ft.
<br /> ' � ` � .��i �.� 5• �: ' Number of SL•ories
<br /> • ' �: • j. ' • , C � � " Basement � ,
<br /> �'; . ' Q�.�� . •J � 4( . Signed By P �( .�..�i�n_d .��. --
<br /> . ;.. . �' , .
<br /> �
<br /> _ . _ . . . "�For '�� i .(_�,...,' �1��"'�,..•. �:.
<br /> • +� ' . . , ' . Owner Phone --�—
<br /> .. ' � DO :IOT S�Z?TE BELO('7 iF?IS LT:�E-FOR CZTY USH O2IL'L ` � .
<br /> .. • _... . . C� .
<br /> . _ Datc ?:eceived �, `I � IIce� Zone � "'7 a �E�Mrvl . �)�-l���C�, �
<br /> ' Plan Check :7urSer ?S -�,4-�l ' Fire Zone � ` '
<br /> � ,\'aluation � C.��C�. �n �Occuoancy Croup r� - 4-
<br /> Pemit Fee ��5• '��' Type of Construction ,(, - n� . �
<br /> ' Plan Check Fcc �• �SJ� ' Occupanl: Load .
<br /> . •,,: 2ota1 Pee Due ' �Q ' �S , sprinklcr� Requir�aT _ _ ' �
<br /> ' �"t-�C I .. • �
<br /> llatc Issucd ' ' ' � . APRROVED'`Fp� GUiLDING FERNIIT. •
<br /> • • . . ... • • ' • . " 'Dateiz.%i:�.�7 � gy I�. -- .
<br /> , , . . � , .
<br />
|