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..�: - <br /> D�ILDING PERMIT APPLICATION ,� �Q ��p'�i <br /> ' , Applicant To Complete Thi� ?orm Y �' !''� <br /> � .3��/�'�75 <br /> ' If more than one huildinq is to be contr�icted, submit a separate permit applica- <br /> tlort tor each buildinq. �l separate permii. will be issued £or each build?nq. <br /> � � Ovner �,�'1���_(>5c�� f�C. ' 'I \�IS/kButlding Address c�'�= : <br /> , . )3dress '�S)Li/ `F l//=i' ��F7=�1 (.,u/1-`/ Lat_ Block ' <br /> �- <br /> City LV(�:�T�A��I Phoney�S� � 65 3 S�.bdivision (Plat) _ • . - <br /> , � � Ezchitect/Engineer ��;t(�(�=5 �l Z�V A-lC ' <br /> "' '"'� City �(_�-�«�� Fhone Ketes s Bounds (Unplatted) <br /> ' ' "i <br /> , :, Contractor �+�n(� , �`l�N S T 1� Sec. 1Yap. Rge � <br /> _ �ddress ( 7 j.�'- 1'l �t,.. ��l' . . . <br /> � �ty _�.�— Phone ��� �� �2�0 q , . � <br /> Duildin Use '•;::;'. <br /> � y� Swte.License Nutcber Desaribe Work to Be Done '.'''., <br /> • : � �i Lzpiration Dat� oss.5 f/'LL'�v /��°5�:��s.v� <br /> �� ' '� . � SRETCH PLOT PLAN H�LOW' • - f <br /> . - � ' • <br /> � ' : i � . , IIae of Building � . <br /> � � . , ' ' . . , ; , � � �'?ew ❑ Addition Q Repair/Remociel - <br /> � . " ; ' � . . ' paluatian of Construction S �t4�� �_ <br /> � . ����• ` : . ' i 32,o�o.� <br /> ��^' . . ', . : •'� ' � �� �TS .' . . PIAT PLAN FtEQUIREFIENTS , . <br /> � ' � • �1 �� . � Zndicate lot size, nane of streets, <br /> + � indicate location and wiflth cf <br /> . . � • " ' �. _ a112ys, locate nronosed and all - <br /> • ��� : ' � . ' existing buildiags, shocu distanres <br /> -- v to property lines, show distances <br /> � � � � ' - between buildings. <br /> ' ; . _. . <br /> ' � � � I.ot size x <br /> . . . <br /> ... . ' . �. • Lot area Sq. Ft. � <br /> r, . � � � - � Size of Rldg. Sc. Ft. � <br /> < ,• • • Number af Stories <br /> '.: ;. • . . . Basement <br /> i.. . . ,. . <br /> `� • ' � Signed By� � � �/ ' �i — <br /> ���/y, ,/���%/ <br /> � . ' For_��'�� .�i �...�_. <br /> . , . . . . � . � Owner Phone :j 53 4 6 �.:l <br /> � � � ' DO NOT S<3ZTE B�:.O['7 THIS LINE-?OR CITY USE OCIL'I <br /> . Date Seceived �J-- '75 Ace Zone _____, _ <br /> ' Plan Check :Iurber �S- ��j � Fire Zone ' <br /> �' Valua�ion '�' �c�. C�i�, �'Cr'() Occunancy Grou� <br /> Pemit Fee Type Mf Construction <br /> S � <br /> ,� Plan Check Fee �•�ZS.� � � Occupant Load � <br /> , • ibtal Fee Due _ Sprinklers Required _ <br /> Date Issued �J�/(o � �_ �. - . <br /> ' • . ' • . . . .• • <br /> '^".t. <br /> „� . , <br /> �}y � r� t,� v ��_ -+ <br /> ^�j :.!�41'�.b �� 4J 4 � <br /> �,�T �riK � .G.:�: ..�'�. <br /> ✓.:�:: p:.�'._ j � sS,�-. <br /> l��4'Y .y'I.. � � O3 <br /> + <br />