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<br /> ,• . . . � ` sOILDZNG PEAMIT APPLICATION � '�'�'L�:z�" '- .�..�p_� . !
<br /> ' „ �� ' � , , � Applicaat To Complete This :orm �� � �' oZ.�
<br /> . ; . �'9J; . y
<br /> . • � Ii more than one buildinq is to be contructed, �ubmit a se arate f6/��/�r
<br /> • • tioa for each buildin P Permit appli�a-
<br /> . (� _ g• �1 separate permit will be issued for each buildinq.
<br /> • �7L�°�r 7'pU� � �'G(//l�9 8nilding Addres� �_�f7�� �ateSf �Pija �
<br /> : . ' . � aaaress .�}7/�' Foresf l��-. r,oe � l / . siock . _
<br /> • . �tY _ �!/P/'Pf� Phone_��`y'- 3;y�% Subdi43sion (Plat) �f��� /�,' i � •
<br /> _ � = Jrehitect/Engineer -- - . . /�iJ�/7'/0%% � �
<br /> ' /� �l/�s i�ri r�I . .
<br /> - �'= •.' "j �tY • p��e !�letes i Bounds (Unplatted) .
<br /> :�' Camtzactor �'��,,J ' Sec. ' y
<br /> �� • TwP• R4e
<br /> -• ;, . �. 1ldazess • 34 � .a� or-� • . . — . .
<br /> .. .;5 CitY -_�:-`�hone 3.� � G Bnilding Dse � f :. .�-;�. �
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<br /> " �yJ S te.License Number ��"'rf'in��� U, >:c.' �;J� ��zcribe Work to He.Done !;� '^►'�
<br /> • • �1 �� ir tion Date -- � . ,r-Q/l� .k�- ' d '�fe ? -� r., .G�,�.r`,-r��
<br /> ' �� s �
<br /> � A .�c� ; SRETCH PLOT PLAN 1 LOiP' .�. C/
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<br /> ' � ' `E- y`' , � ��=3�� Use of Buildiriq � '
<br /> ' � � � w :� �. .
<br /> ,� � � :X, �, . . . . . , . . � � .� �.. .
<br /> - � � �;. •. • • QNeit � Addition Q Repair/Remo&el
<br /> �. •\:.SU,i'� � �`"�'\. x ;..��.' . � -.� . . �.r. '. .
<br /> X. ��' ` ��` ��a=3 � � � I' "• oaluation of Constzuction S 2`-�X� �"
<br /> x • - • ppp���{{{��'..y```��
<br /> �� '�i � `. �`� �'•'• ��. ;�' �-�'� • , , PIAT PLAN REQUZREFSENTS : .
<br /> • � —�� - .`�} 4 ' Inaicate lot size, name of streets, �
<br /> , 4 �. �v iI .• . : • , �� ; 'in8icate location and width of ,
<br /> . ;.
<br /> '�-- �,; ' - alleys, locate proposed ar.d all
<br /> ' ,'� ' �. ' -.r.��,. :_/F <-073 �� . � ' eXisting buildinqs, show distances
<br /> ' •. • '� � � ' : .. ' . .N= • . to property lines, show distances
<br /> •. + � � W . _ �' , between buildings. .
<br /> . . � n ��
<br /> _, . , ,C . � �+ , • Lot size i � x�--�=�
<br /> ..:- X � � .
<br /> �t � _ I v ' � • , . I.ot area � / �; � Sq. Ft.
<br /> ' � � , : j � Size of Bl�cq: Sq. Ft. _ _
<br /> � � Number of Stories
<br /> ' � '= ' i � � � ' � Basement �
<br /> 4 r• % V 1 '
<br /> � = \(Signed BY rt� ��..�_ �. ,.
<br /> , i.• j � . i . �� .
<br /> .. _ . � � For /
<br /> • t �• Owner Phone
<br /> . ,_ S'.' _ _ __ .-_.._
<br /> • -k `` ' 's' ��.,' . . , '
<br /> �• � DO :IOT SC:iITE S=LO['7 THIS LI:IE-r^OR CITY USE OiJL'I `
<br /> • Date �eceived l7 'Z�. IIse Zone . �
<br /> ' Plaa Check, :7urSer `7S- '3c�_' Fire Zone -
<br /> ,. .Yalvation 25��• � Occuoancy Grou�
<br /> Pemit Fee Z.4. �� .
<br /> Type of Canstruction
<br /> Plan Check Fee l Z • �v Occupant Load •
<br /> . ; Total Fee Due . �lo - �� Sprinklers Required ' �
<br /> Date Issucd ' ' ' /
<br /> . . . a,��o �a�ri,} �
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