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I\ <br /> _'�" __ ._ ._ . . _ ._ ._ .. . . . ... . .. .. . . ,�// (��// <br /> /✓ �J / ( ': <br /> DUILDING PER6IIT APPLICATION / � <br /> , Applicant To Complete This ^orm /v/ 3���a�%y <br /> Zf more than one building is to be contructed, submit a separate permit app2ica- <br /> tion for each buil3ing. A separate permit will be issued for each buildinq. <br /> Owner T yc<< �' C%i r : S�d h�r-c, Bui.lding Address �63D /_=t-,,,� c ,:,�a �� C,.�.:' � <br /> Address � ��3� Lot Block � <br /> City Phone Subdivision (Plat) <br /> Architect/Engineer <br /> City _L'�hone Metes 6 Bounds (Unplatted) <br /> Contractor ��� i�� !� �� r� p-,- 5 e �- Sec. J�_ Twp.�_ Rge /� <br /> Address /�•D. r�a X � 3 � � ] � <br /> oCJ 1_ � <br /> City /a��- 7'l a n�L Yhane ,35� -3(co Building Use ST� �- P _ <br /> � <br /> State License Number �?3 �d/- o�>y2 Describe Work to Be Done r�r -,•� { f'� �.r' <br /> Expiration Date �9 �L T n a 7 i•„�s d'- Fn�,-,,, .! a �i o>- Lc.��1� <br /> � � 5 <br /> SKETCti PLOT PLAN BELOW <br /> Use of Building <br /> �)� � Gpy,1T12�"G��� � []New ❑ Addition Q Repair/Remodel <br /> �(Z�c] Ta Gcsy�S'CIZUG"� � Valuation of Construction S <br /> �U �.����0� �,' TE'��2 :�. PIAT PLAN REQUIR&�IENTS . <br /> .�Ir, � ���� ���,X����,�'z� Indicate lot si�e, name o£ streets, <br /> � indicate location and width of <br /> �� � alleys, locate nroposed and all <br /> �������� existing buildir.gs, ,show distances <br /> r •■ to property lines, show distances <br /> � between buildings. <br /> Lot size x <br /> � � Lot area Sq. Ft. ' <br /> . � Size of Bldg. Sq. Ft. � <br /> Number of Stories � <br /> � <br /> - � Basement � <br /> . Signcd By ����c,tQ��-- <br /> I <br /> For /-1. �! _ l� 7,a� P,- S � .-. � <br /> Owner Phone :'� 7� , u� �. <br /> DO NOT WRITC 6ELG�7 THIS LI�z-FOR CITY USE OtILY � <br /> Date ^oc^_:•:c3 U-e Zone ' <br /> Plan C:�ec}: 4ur.,bcr Fire Zone ' <br /> Valuation Occuoancy Group k <br /> Pemit Fee Type of Construction , I <br /> • i <br /> Plan Checl: Fee Occupant Load � <br /> Total Fee *�uc Sprinklers Required ` <br /> �a.c �ssu�d CITY OF EVERGTT I <br /> � APPRONrD FQ� EUl!D'::^ PGR^�11T <br /> [�:�- <br />