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w <br />'. ��.Kt <br />-� ' �' i ' ,. , • � Rnplicant To CompleterThis :orm �' l�Ss`�� ' �:� � � . .,,'y' . <br />• � i�//,'/! z <br />, • Y! more than one buildinq is to be contr�ir, �d, submit a separatc permit applica- • <br />., tion for each buildin3. A separate permit C�11 be .,sued For each buildinq. <br />. � ' Ot�ner �t_G „I ) 1�7��5 • -I-r� c Suildinq Addzess � . <br />� . �'. � 1lddresa _-1 1 �Q RN�l6r7,7.n, � W+{'� Lot / 3� Hlock ' , <br />-, . City �,i,i�rC�7 Phone?,��- �yu'U SubdiVision (Plat) 7,��l�+ec s� %� «s 1�� �, <br />• � - Jsthitect En � . -� � . ' • , • , <br />_ J gineer �nwi'r7�-G � <br />_ .'.',;, : • "_'� C1ty �tlRnzrU� Phone 2'SZ-tX�o Q Metes 6 Bouads (Unplatted) ' • <br />_ �;�•: Contractor � r°T"A CrOAJ 5 i Yu.f t i^, o�� Sec.� Twp. 2�� Rge 5� . ' <br />. ,..� . — . . <br />_ � ;, : �• lddzess I�. �� ��� r 44 �f- • . , <br />.�� City'-/�MiJ!Sv�«1- Phone /,ti"�l ^U�1 S� Bnilding IIse ZF�r'7�1 � ��^.-��3:`'�.; =�^Z <br />� .�� . ; . . , . . _.:�'r .' <br />••� �'�} State, License Ncn6er 223 - d I- 1"z5 5 5 ,9escribe Work to Be .Done �`� <br />: .• .1 Hcpiration Dat� '�l I i � �. G, '' f Lr� up �7/_ ��-5 iLr-r /L..r t .' •. - . <br />� t.�' - SRETCH PLOT PL.1N BELOT•T' • � <br />�-t.-�� •. „ , .. � . . .' <br />�. . . - .. _- ilse o£. Buildirig ���M � � A-LPs r-� <br />a- � � . ,_ � �New ❑ Addition (�Repair/Recio`el <br />. . � .; � . . . . ' i <br />; • . " " . � • ;' "• Valuation of Construction $ � �j, v a U <br />� '• . . . .. - .. . : I .. • - <br />�- . - .: .'. -, � - - PIAT PLAN REQIII_TiE�lE.ITS . = - <br />----.. - . . . _ . . . , � . , . ; { <br />� , . . � <br />�• ; • • ' � , . ' � • • ' ' Itldicate lot size, na�e of streets, � <br />_ :.! � _ : : , -: �_ - ' + � •indicate locztior. and widtn o� .. • <br />,, _ ti•• .. : alleys, 7.ocate pronosed ar.d all <br />' '`( ' •' existing bnildi.-.gs, sho:r dis:ances � <br />_ ? 3 =1 � ' .�:^'" -� v. � : ' . .�'=.. ' . . to property lir.es, show distances <br />• S : ' : � " between buildings. • <br />. ' . . . . � 22��-s.v Lrr2 ' .. <br />• ;� '• _. . a' . . . ' . . . , iAt S1Z@ X ' . <br />. -• s • • ' • " ,' .Lot area Sq. Ft. <br />' .•, ' r, = , , ' . ,. 'i;. .. . . - . . Size of Bldg. Sa. Ft. <br />' � `�j . . ' . • Number of Stories <br />. f: . <br />:_ - i� . - . . Sasement � <br />.._- ' . <br />,y �r �-^ <br />'� _ ' . � • • . . . Signed BY P�.,. r H�-.2-0:�.�'-�h' <br />. ;;. - . — U <br />_ . . . . . � ... �'or 1 �� a,� w Qn.� s . � c • <br />. - Owtier Phone i C4 -U� <br />..' � DO :10.^ h':2T_T� H?LOE7 THIS LI:dE-?OR CITY US 0;7L'1 � <br />. Dnee Seceived �f I IZI%`�^ � IIce•Zo.ie . . <br />' Plan C;�ec:: :7ucber �% � — 4--Z-C� ' Fire 2one ' <br />•. Yaluation � .i'�J� ��� �� Occunancy Crov,� <br />� Peznit Fee �cJZ � � � � �Type of Canstruction <br />' �Plan Check Fee -�7�j. � �� Occupant Load • <br />. �� <br />. Total Fee Due `� `� SprinY.lcrs Rer,uired ' , <br />Daic Issucd . • ' • • • CITY bF. EV.�R�I'T <br />• •• . � . • APPRO'JGt�"fuR.,LUf{�DING PERNIIT. , . <br />� �.. <br />. : , . ; , Date �� 1-�('�.a--_•By � ' � �. � . <br />, � <br />' _T <br />