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�, , <br />_ � : � . '� ' � ' ��ILDINC PEHMIT APPLICATION , � � • ' ; ,i: � <br />_ ,• � , , � �plicant To Complete This Form �� �. .l <br />� '• ' '•.,i <br />� � Si more than one buildinq iv to be contructed, submit a se arate � l <br />� .I : tion for each buildin P Pe�it applica- <br />, 3. A separate permit vill be issued Eor each buildinq. <br />• �` ��r � HR' � �� �✓N�AG E L Huilding Addzess ' ��}-M �� ' . <br />' � : ' .� 3 F/lZ i� � <br />�ddzess r.. ;? <br />• • � � �t-- � �',� 91ocx O DD D • 00; <br />•; :��, L VE'iZL'Tl phone 3��'��/� Subdi4lsion criae� :. <br />' � �sehitect hn . ' <br />_ /' gineer G� ✓ W GL�. l%�•( EN/ ?'�I( �Q. C f S • ' <br />� :.. I <br />_ 't :. ..i Citp • Phone Ftetes i Bounds (Unplatted) • <br />:.f . i , . <br />. .��. �tIdCLOI ' � � SlC. . . . . , ' <br />.� . '�'P• Rqe <br />_ � ;, . r• llddress ' . ' • ' , . <br />• j �tY Phone Bu3ldinq Use . . . :�.:. � <br />4 •,:, _�,;`Y. <br />State License Ncaber �� <br />� • Describe Work to Be.Done �� <br />.. `� • . <br />; •.1 Lzpiration Dat� . FEAI L E• S/O d�� Y R' KD . '` <br />��' � . ' SKETCH YLOT PL,LN BELOT4' • . - <br />'f�:,� ' . , • � �se of.Buildirig � <br />. .. . <br />�� . + ' . � •L]New ❑ Addition <br />�. . i ❑ Repair/Remo�el <br />' . . � • � /� b <br />Valuation of Construction $ '7 d� �' <br />� • •'. ` ` . . � � . ., . � ' PLOT PLAN REQUZ_TtEb1E:]TS . <br />. • . . . '' � 1. • . - -�. <br />� � � � � � • A • ' Indicate lat size, nane of streets, <br />' • •�� ' •iadicate location and width o� <br />_ ' � : , ' .: '. . • . � (j� , � <br />, �._• . ':: ' �• : • • alleys, locate proposefi a: d all ' <br />' r� �_ � ' � Cxisting buildiaqs, shc:a distances <br />' i�}� , '��� ' y � • ; � • ' • • to propezty lines, show distances <br />•. � +. � • . � . between buildings. . <br />;� � ', � . � . 'L + �' Lot size X ' . . <br />� .•i- • � IC/� . . . bot area ' S Ft. <br />4• <br />.. �` �. .K Crq,uQ . size of Bld4• Sq. Ft. <br />Number of Stories <br />' � ': 't ' ��� Sasement <br />r:.._- _ . . • . <br />.� =' ' . ' . . . ' �Signed By . <br />_ ;. . . . . • . <br />• � Dace �eceived <br />DO :IOT Si3?TE 9�LOF7 <br />, (�,.. /� , • <br />' Ylan Check :Iur.ber '-- � <br />• Yaluation Q��, � � <br />. . . • Femit Fee •t� � O �/;.. <br />' Plan Check Fee <br />. ',� ibial Fee Due `�� � U <br />Da[c Zssucd � ���7 c_p <br />• •. - � <br />. � � 7� � � � ..� <br />Foz <br />Owner Phone <br />LI:IE-i OR <br />U::e• Zone <br />Fire Zone <br />Occuoancy Croup <br />Type of Construction <br />Occupant Load • <br />Sprinklcrs Required _ <br />.. . . . . � . <br />., .,, <br />� <br />0 <br />� <br />a <br />� <br />