|
.. �, : _ � ' ' DOILDING PERMIT APPLICATZON '�"""`� ���"��'�� �''�� �
<br /> - , ; , , Applieant To Complete This :orm ' `�
<br /> ; • . , /9���
<br /> • it more th�n ona.buildinq is to be co�tructed, submit a separate permit applica-
<br /> . . tloa for each buildin3. �1 separate permit will be issued for each buildinq. �a��/7,
<br /> . - ' �� U ' .l. �,�r�rt�r ' y/. g •
<br /> J Bulldinq Addzess � �/ ��{y�' ,
<br /> � . lddresa ,/� - .
<br /> . � .�u� /!�i�.,.� Lot�D I _ Slock
<br /> - . C1tY 1�j� �' Phone�.6'�f_ ,3p6/ Subdl4ision (Plat) _�oZeo�7 f � •
<br /> : --�r—
<br /> _ � = �rehitect/Enqineer — � � 1 /� Q, , .
<br /> . �(7/0�1� 'lll 2�ln..jv1 / /
<br /> _ �=• • =; �itY — Phone — Netes i Bounds (Unplatted) .
<br /> :�' Contractor jL G�.1_G`r�O�i�Z, � Sec. �Wp, Rge , -
<br /> ;. r. . ;. ���� .�G � » ;I • . - . • .
<br /> �.;: � t.�, �
<br /> • � Y " Phane �/�!-;?U 6 Snilding Use • . ` �
<br /> ':`•1 . " ., . • ".:.. _�•.:.i. ..
<br /> •,.
<br /> • �'�} State,License Num6er �t/�,,,, �yar�n"�.Describe Work to Be Done �,�, ���4,
<br /> - ' u .
<br /> i
<br /> : �I iration Dat� ' �_����. n� �� � /`� .
<br /> �' � , SRETCH PLOT PLAN 8 LOTP' /�'='a � � ` -
<br /> � : . - � - W.,: . � "• . � . , . �
<br /> � � � Qse of Buildiriq
<br /> ' . . . '`�j .- � .
<br /> �� : �,y� •• . ,,, �New j$$Addition ❑Repair/Remo:iel
<br /> . . ..; � � ��. � � , . . �� . �
<br /> �" � � , • paluation of Construction ; �'�
<br /> � - .— i .
<br /> �. . ' � � ` .. _ `�<��' <' 29 . .� ; . � ' . . PIAT PLF1N REQUIREI�ffiNTS .
<br /> � • I .� � \\� ���•--�. . • . " - .
<br /> .' + ' Indicate lot size name of streets, �
<br /> " ' , f C ��y?`_�9 �. f� .—>, ' ` 'indicate locationland width of ,
<br /> � . _ : • alleys, lacate pr000sed ar.d all
<br /> . • �•' . . �
<br /> i�� _ ���_ .. � : •-'j� ' Pacisting buildiags, show distances
<br /> � . , '� ' • . to property lines, show distances
<br /> � !. y �`�� � �� � , _ ' , between buildings. .
<br /> , • . � � ' . � F—a 3'—> . c�p - .
<br /> . � ., � • 7.o'c size �x ��/
<br /> .•`= ��� ? y� . . Lot area �'/D (� Sq. Ft.
<br /> �j r ;\ � � . Size of Bldq. Sg. Ft.
<br /> � � Number of Stories �
<br /> .`. :: . i �� . �' � � � 8a:>emept r,, �,. _
<br /> '. � �
<br /> �� : �, Signed Sy � r
<br /> . �.� � �. , .
<br /> • . ' F°'� J,� . `" � For
<br /> x
<br /> � �I � • Owner Phone
<br /> . � . '
<br /> � .. ' � y� DO� ^` C 9=L •'7 THIS LI:IE-POR CITY USE Oi7L'1 �
<br /> _ '
<br /> _ Date �eceived � 1Z '75 U�e� Zone �--` SifJC-at.�. .�yy,t � L.��
<br /> - • — i .
<br /> ' Plan Caeck. :iurSer 7 S -�- ' £ire Zone �3 •
<br /> a
<br /> .Valuation _ �{��J�O•� Occunancy Grou� L
<br /> Petnit Fee ��� �"^� '
<br /> Type of Construction �V � r� ` .
<br /> Plan Check Fee ( �• ���� �
<br /> Occupant Load
<br /> qG r��
<br /> . � ibial Fee Due `'�"C�- �� Sprinklers Re d ' �
<br /> . � �,'�''� o- '
<br /> Date �ssued /"7, / ' - �__ ' 'l1PPROV.ED FOR G�UIL-DRJG PERMIT
<br /> . , . ..
<br /> • . . . . • .:Datc j.._ '� �_.��`�;�� �Y� �_,�,i� '
<br /> �T
<br />
|