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<br />� ,• • , • � • ' ': • • • ' EOILDINC PERMIT APPLICATION . • '-_- i (�'k:"'.��. i,�
<br />- • : IIpplicant To Complete This :orm '•:.���5;,��
<br />�,� ' • • ' • '• /� J�
<br />, • Si cwre than one buildinq is to he contructed, syhmit-n--separnte-pesmi.t applica-'"
<br />.: tioa foz each buildir.3. .l separate permit.wirl be issued far.each buildinq.
<br />. � � Ovnet �/yT/fc�,d � /: • Mr�F2r/N/� � Sni2dinq Addzess �3�J�� �edCc°� �iu = �
<br />t . � , ' � 3{ddress a /G /�k A T H r i4 . Lot /`/y� !?:i Block ?d`�7C� . / r
<br />. ; .
<br />� City �(.'�/;� /T PhoneA,( n_ =r� Y2 Snbdi4lsioa .(YlatJ cF �/i;c%jt /% /� � ,
<br />� 1 ✓i9/o K ' „ -. .
<br />' �'��-.;Ci% /1�C.1 7C(.,[.;,: � ri Fl«.,ao. -, �, : irt p.,rt
<br />� �. .�kCi1�tECh��I1CJ1II00=�'1+rtAF�� CaNS�� ' tr,' !%�i 'F �'ii'.115 ri}x i D' JNy� ..:..;,� � .
<br />, � i r '.
<br />r.' :� �..:j City � �� id t•l i Phone /� y 2 c� U?_ LSet^.s t Bounds (Unplatted) ' •
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<br />_ ;�•; Caatractor 7'7�; ,vv ✓�%�'iR �� i / Ni � • Sec. iwp. Rge _
<br />..� . . . .
<br />� .+, •:' 1lddress /��L /i-rA Th-t'tl • . ,
<br />. �! Cit �,ic-,I�£IT Phone ���y'L Snildin Use i�tis�t /��.u��c�-�'Y'iz�- �
<br />. Y / 4 i , , ��: -
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<br />- �� Etate,License N�er Describe Work to Be_Done /I/�i,u CG�✓�T;o�r,�,-i��;i
<br />� . . . ..
<br />• ;.'t Ezpiration Dat� � ' ' '
<br />� ..�' � � • S1�TCH PLOT PLAPI IIELOSI' • • � .
<br />� l . .. • � . . . .
<br />Ose of Buildirig
<br />�+ � � � . - - • .' ' . •. ... ' ' 1.1New ❑ �ddition 0 Repair/Remo�el
<br />� '�. � ' .-• � ,� . : - �Valuatian of Construction $ � •
<br />; '. .' � _ .... . � . .
<br />.r�. . �t �� - : .'. .-.. . . ' � , . PLOT PLF1N REQUI?2Et1ENTS .. . ' .
<br />---" _ • . . ' . ' � . • � ' � • � . -?
<br />� • i . . • - . - • , • . • ' j=tdieate lot size, na�e of streets,
<br />•' �• ' � � '� � 'indicate location aa� wicth o: � �
<br />. ;� � • " i:= '.- • • alleys, lxate proposec ar.d all
<br />• :•` , � ' '� . . '' ' • existing baildi: gs, sho:v distances
<br />� i _ ,� ,':+_ � - - � • � • � - � . • �'� ' . . to property lines, show distances
<br />� -� - ' between buildings. •
<br />�•: ' � . "' ' ' . '
<br />. : c . _ .. . . .. . _ . . 7.ot size x . ' ..
<br />" • �� �:.i- s . . �. • ' ,' • - . '. Lot azea � Sq. Ft.
<br />• �. �: . . ' .. • ' � . Size of Bldq. Sa. Ft.
<br />-� �'� '. • ' ' Number of Stories
<br />' :: . � ' . . • . .. . Sasement
<br />.r'.,_- ' ' ' J ' �:,.
<br />'.� •:. ' � • : . . • �-. Signed By � � /%i`-,�,.�,.-:
<br />' — .�
<br />. , - . , •
<br />. . • . . .. For
<br />, , _ Ownez Phone (j � !1 °i"G �! 2
<br />,_' � DO :IOT SC2?T?; B�LO[7 TfiSS LI:dE-FOR CIT'_' �'S' O.IL'1' ,__ ��
<br />. Dxte Seceived .� 'Z'Z/ � II�e• Zone �-- ��i�v�;� F��i: GG li%�
<br />' Plan Chec� :7ur.ber %CL`-7iU" "Z ' Fire Zone '�3_ '
<br />• Valua�ion y-lJ,�.� �U Occuoancy Grou�
<br />. . • UU ,
<br />pemit Fee �'� %� ' ' �Rype of Construction '
<br />- � � .
<br />�Plan Check Fee �I�). � ' Occupant Load
<br />. � Toial Fee Due . ' SprinY.lcrs Required _ �
<br />Date Issucd ' � ' � � . ' ,' . , • .
<br />� � .' • ... . . • • • ' .. �:� •�. • • . .
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