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� . .. � . • u�ia.uin� rLtu'1i1 I:itlLll:tC1'1U.7 , . • ���j :. ,:.�j .
<br /> Y � i , � � 9spplicant To Cc:�plet:c This :orm � ���'T."' / Jr '� '
<br /> , • ' Ii more than one buildinq is t�� be contructed, submit a separate permit applic�
<br /> . , tlon for cach buildin3. A seFaratc permit will bc i�sucd for cach buildinq.
<br /> � � � Amer �, � L,� � 8uildinq nddress � �j�„Z 9-���'-�in,¢�,r�%'N`I J-
<br /> � • ` • � lddress .i3.� -F� ,�es ° �a< Lot rf elock � ' .
<br /> � . .
<br /> . City ��- Phone355 -`]SO(o Subdi4ision (Plat) � • _
<br /> _ ' � irchitect/Engineer � • ��L • � ' � '
<br /> ' : � • �—T
<br /> _ !;� :.. .=� City Phon Hetes i IIounds (Unplatted) ' _
<br /> � '., ;,•: Cantractor � Sec. Twp. Rge �
<br /> _ . ...� . . .
<br /> - ;, : r• Mdress _ . .
<br /> ., .'f tity • Phone HnildSng Use Tv�,+ ,(tt//.-���1i'`_;;__`_:�
<br /> • • `J � State License Nwsber �� Describe Work to Be -Done c ~ ��'
<br /> r . ;}�..l�43�I'
<br /> : . .1 Ezpiration Dat� `�' '��p�e,rt�LD r'�G•-1/L�'�„./2e.,�P �o-.+1L-- :. ,
<br /> ' t�' � • SICETCH PLOT PI.A?7 BELOW' �• • . . _ • .
<br /> ti: ' ':� " • � � + Ose of Buildirig � ��O.e-,, _, . � �
<br /> w u^•
<br /> . ,',. , . ;
<br /> � • . : ' '� ; _ �' —�-- .. . � .. . []New �Addition ❑ Repair/Reno5el
<br /> . . �.i. . . . . . _� c �\ .7 �� �
<br /> _.aS�.LSCc__
<br /> �. \ .� . � • � . . i• oaluation of Construction $ �� �
<br /> : •� ' . '. .- . . .': •: `I : . ,
<br /> -�- . '. -�.. ,,'�'. :'., � S.Si�• .•.::� ' � ' , , P7AT PLAN REQUIREtL-^NTS . : _`i�
<br /> � : �' . „ ' . � •r
<br /> ., i • • ' \ �;: , • � • • `� ' ID�7icate lot siz.e, na�e of streets,
<br /> _ , '� • -l'• . � �� :. � •indicate location aad width of .. �
<br /> - , j • � �j�(,Q�L ` :' �• alleys, locate pr000sed a.^.d all '
<br /> _ :-'j . ' . . / ' � ' � ' �'•` existing buildiags, sho:� dis.ances ,
<br /> ' .�:�„- `�, . �
<br /> _ . ; +1 '- ��v„ ��}� - to property lines, show distanr.es
<br /> .� ��CJ � betwcen buildings.
<br /> ` �, � . _ • . .
<br /> , : . :� .. . •�'� ,. � ' . 7.ot size 70, x� '
<br /> . �� . .-= � :�
<br /> � '. Lot area 7�00 Sq. £t.
<br /> � , r, • , . . , Sizc of Blzq. Sa. Ft_
<br /> • ' �'; _ � � � . . Number of Stories y �
<br /> - ' :: • � � . �%� = ' Basement ' —
<br /> r.: . _ \ • • .
<br /> '� ; '— � ' . ' �``7�' �� � Signed By ��Cca
<br /> ..''_ . � . . .. %_ . � For „ZO��n 1L�- —
<br /> . ` Owncr Phone - .SO G�
<br /> . . -_ -7 . ' P����C'��� �
<br /> � •,' � DO 210: 1':ZOS B'LOI'T THIS LI:IE-rOR CITY US�Oi7L'1 ` �
<br /> �• - Datc �ace?ved � (I S I� � � IIce• Zone . , ,
<br /> ' Plaa Chec;: :7a.Ser T— ' Fire Zone Z "
<br /> ' �� . . . .
<br /> . Yaluntion 2SZ�' Occuoancy Gro� � �-Z
<br /> • Yemit Fee � � � � � ' ' Typc of Construction .7 - V - ' .
<br /> � Ylan Check Fce Occupant Load _
<br /> . �,� Sbial Fec Auc . �' � � � Sprinklcrs R �i� ' _ '
<br /> • ci���5. ._ _
<br /> aatc �ssucd • E � S�_ �� � APPR0�;�4.FGR�BU1L•DIL�G PERMI7 . ,
<br /> . •. . � • . •:,,�s, •• . • . . ,
<br /> � :�' � ' . � � oate �I t� �7��.-.BY, 1�--+�----�--'"' � .
<br /> • . _ . . , '
<br /> � . • � . � • ' . • _ . • . . . .�,
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