Laserfiche WebLink
. . •. <br />' ; �' • ' BOILDING PERMIT APPLICATION � Gi � : <br />-- / .3�z.:.j <br />_ • � }Ipplicant To Complete This ?orm <br />.. . • . . . !i/p �S/ <br />,. • If more than one buildinq is to be contructed, submit a separate penait applica- <br />.. Lion for each buildin3. �l,separate permit will be issued for each buildiiig: <br />. ' � Osmer =�<1ti�E� liq�/.Sh Huilding Address (05� f �-VC��lt/��/V � <br />� , Address /r. �J� F�C�»ii�� Lot Slock <br />City ��� �fi Phone 3s3 �/�� � SulxiiLision (Plat) • <br />' • architect/Enqineer l(A,.SG ✓is',UJ�K/ �A.'�� . <br />''.� City �:��f� Phone Metes S Bounds (Unplatted) <br />- - 1 �—!- /� .. <br />. ;, Contractor G/i1S�11��� ��M� /Jvi�G/riS Sec. Twp. Rge � <br />: � lsddress 34d 5 = ,c�P/� J/ . . . . <br />� <br />�' City �c�r��f� Phone ��5�/-0 1�3 Building Use �'?,•; `'s',., <br />�� �`�� £tate License Number Describe Work to Be Done `l'��. <br />r� <br />• � �i Expiration Dat� � <br />:�" � � SRET:'u' ?LOT PI.�1L7 BELOf•7� • <br />. '.; � IIse of Building T,(%�/'L I�N <br />� � 1 ' ,.' ,' . , , . ' L]New Ll Addition �Repair/Remo::el <br />_ • � � r7 �_ � <br />' _ � : Valuation of Construction $ �c6� <br />o • . . <br />-..... . . .. ' - � � . PIAT PLAN F2EQUZ?2E.�Sr NTS . _ . <br />• � . <br />'. ' 1 <br />. I <br />' '' � <br />_ " ; "� <br />:. <br />a <br />r- 'G : <br />� <br />Ii�dicate lot size, nane of streets, <br />• ' indicate location and width of <br />_ alleys, locate aroposefi ar.d all <br />. existing buildi :gs, shoa� distances <br />. - . to property lines, show distances <br />' • betWeen buildings. <br />Lot size ,2,2� x / b � <br />Eot area � Sq. Ft. <br />Size of Bldg. Sa. Ft. <br />Number of Stories <br />Basement <br />Signed By <br />For �>���,zc, �� <br />T� ner Phone ?,,; � �/ / <br />DO :IOT NZT_T� B�LO':! THIS LI:IE-cOR CITY JSB <br />Date T�ceived �P//7/7S� <br />- . . /,, <br />Plan Chec;: :7urber 7`j - Z� Y <br />Va:uation �J��Q �� <br />Pemit Fee ���• �� <br />Plan Check Fee GD �/ / <br />� Total Fee Due � �'J 2. g <br />. �. <br />. Datc Issued •� 7 j <br />Uce Zonr <br />Fire Zone <br />Occuoancy Group _ <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />\ <br />� <br />