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. , . . _ .- . .._... �_ �.-' .=,.e' '-'
<br />^ ' , } . '. . • • 80ILDING PEIiMIT APPLICATION . ,' ' , •'" c� Y
<br />_ •• . • • •• Jlpplicant To Complete This :or�n / ��/; �;i
<br />, •• ' Zi more than one buildinq is tn be contructed, submit a �eparate permit applica-��,
<br />. tlon for each buildin3. ��1:�oarate permit will be issucd foz each buildinq, j
<br />. � �� �tlIIe! (ly:�r�'�i;�':�_� ;:��: `%��(P�'�li;` .(fLt�����c�� Suildinq Address ,.�? J �� �LLI'''l,✓��1,'� '
<br />. � • ;/J )ddress 6 q��`� }C �. � N'i ) l`i.�. Lot��_ Pixk '
<br />. !1 Ct�y �VCY�iy� phone%S�'_}=f5� • .
<br />5ubdibision (Plat) , �` L l.y'y�E 4
<br />_ � - J�rcliitect/Engineer �OJ�f C � i/��d.� r°i" �'"'T`'� $ � �-}��J. j�-1-� L G s .i" . .
<br />_ .• .;+ : �. -� City • Phone Metes s Dounds (Unplatte@) _ •
<br />:., . �i Il . � -
<br />_ ;,' Cantractor T� Oli�l �' QI1�/ � eV' Sec. _ Twp. Rge � �
<br />. ..� , . .
<br />_' ; • n:uJsess ' . ,
<br />_ . � . - Q , � .
<br />,. �1 C3ty Phone Hnildinq Use �GG1 •C' �"f ' • •` q_� :,
<br />. ;; . _. , . . , -�
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<br />�'�� Stxte.License W�er _ _ IIescribe hork to Se Dane ���� '�* Y
<br />6 : �'t Ez�iraei_� n�t� -- '�i'll�cEt�`L• �-�l��l:1Q.�-e,c• :i9L. ' .
<br />� •1: .. ' . $�;T(:'ti PLOT PI.A?7 BELOrd• • '�/-"�"""'��: � �'` i �"'4GlG '
<br />- ., j . � . .._.__-r/,. �v � '- • Dse of Building '�� Gl�� c$G = — �
<br />� : � r __-- .. . . . . . .
<br />� � . � ' . . � � � /; I�New � Addition Q Repair/Rer.iocel
<br />;. . ' . ' : �.
<br />. . .; • ' ' � .
<br />�. . � • ' , . ; • Veluafion of Ccnstruction $'�t2p0� �
<br />; _ N I . '� '
<br />�..`- N� .• .�: .... .. .._ ' �11- � . , PZ7T PL21DT REQUIPs.:�SENTS . .
<br />� . ..
<br />� . , _ . .
<br />, .p. 1�"' . .: . .. '• ' Ilti3zca�e lot size, anne of stree:s.
<br />�+ � • � � .-' W ' �� •indicate location and width of �
<br />. � :'
<br />,� -'� i:� _�-. -� • alleys, locate propo=.e3 ar.d all
<br />:�y � ,, '_ .- _ _ , .��� � . ?a � • Cacisting buildiags, sh.:a distances
<br />:�.� . - .�, -�� � -• -- v ! . � ' to property lines, show distances
<br />: .. . between buildings.
<br />� . . � " �ir � � I� � .
<br />r . • • � � '� I • �� f � 7At Si2e / ]C �, r . : � .
<br />. . .� . 'r '. : . , �. . . �
<br />' - , . Lot area � 6 �g 5' __ _ sq. rt. � (J�, j;
<br />' . ` \y�. ?if,�':�. • ' � 8ize of Bldg �� Sa. Ft. uc`i`�':^i,
<br />r.. .. .
<br />" i .. � . . ' lhuaber of 5tories � __
<br />, • :: ,i' � HO.wS-C . • 6.i Sascment /�/p _
<br />!.. _ ' ' . I �� ' T ; i � � )' _' � � .;,. .
<br />`� _: �- � � Signed By a�{,`�fl.i.�:..'r' 1�,, t•
<br />W� . �.'i;_. • 3�' ' � .
<br />� :: � .
<br />' -i'� _J ' S . • �p For
<br />- - • .`75� I� �f: . . �� awner Phone
<br />' . FL e ��'h,� • f�� • ��„ -- . : • � _
<br />' � DO NOT SS:2STL' 9�LOC7 THIS I.Z:7E-POR ^_IiY USE OiIL'l ` .
<br />, _ ._ Date �eceived � � �T(T_S � � II�e� Zone • Y.' .
<br />' Plan Chec;: :7ur..5er ' ' Fice Zone '
<br />Va:uation
<br />( 'Z��cj � ��" Occuoancy Group
<br />. . . , • o �. ' .
<br />Pemit Fee (Z_- ' Type of Construction _
<br />PSan Giecl:Fee Occupant Load • _,
<br />. � ibCal Fee Duc , J�--• �� Sprl.nY.lcr� Required � .
<br />• .. ' Date Issucd �{TI ��-i�' . . « . . . . .' , _
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