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,,, ^�\ <br /> �,. <br /> � Applicant To Complete�This 'orm ��� � '� � <br /> . � <br /> If more than one building is to be contruc�ed, submit a separate permit applica- 1 <br /> tion for each building. 11 separate permit will be issued for each buildin9. 3 <br /> � Owner ,�,�(�C,E K�J/�J/�l , /r Buildinq Address 29��� ��`1�£ST �Ec� �� � <br /> Address /_9�� /Z+'�C�tSj ViF«� ���_ L•�t �� �� Block � � � <br /> ���-('��� Subdivision (Plat) ' � <br /> City �I�'P�l Phone � _ <br /> 1 / �/ 1 / � <br /> Architect/Engineer V�� � r / V� -«� - I <br /> City Phone Nates s Bounds (Unplatted) � <br /> S <br /> Contractor !2(x� i�,C//�fl�� CS�Lr_� Sec. 7Wp. Rge � <br /> Address ZJ/�rs �C-`/��T YirLC� .G�F'- _ � <br /> /I � � <br /> City ��'��C.� Phone �S���S✓ Fuildinq Use u[yU� � <br /> State License Number Lescribe Work to Be Done �N�c ns� : � <br /> Expiration Date �j("l5%/n.'C7 ��firc�. �!`/�T /^,ll 4 <br /> SICETCH PLOT PL71N BELOW _G7����� . � <br /> ( ;�D��Px)�l.roe�. sD~ ��i�'����� • L'c:e of Building . <br /> ' ��NFa Lo�t �+6�� � ❑!dew ❑ Addition �r] Repair/Remodel <br /> � <br /> ��� �('.� (�l <br /> _Ar I � � �,'pr �'aluation of Construction $ �' ` <br /> � ' f�(�U `>� Y�27 � /� �� / -�� : <br /> t PLOT PLAN REQl1IRE9fE:ITS <br /> Zt+ ,�y�'�` E� <br /> � ' � � InAicate lnt :ize, name of stre�ts. <br /> ,=�_,_l..��; ,:�...1 indicate locat.icn and wi�tn oi <br /> ,� ' ��.;�„2 .� � � :- alleys, locate proposed ana all <br /> I — � / � ,_;,,r,�,:.; existing buildinas, .show distances <br /> _ �� � � � to properts lines, show distances <br /> � � — Q` � - between buildings. <br /> , ���j�ic'C� ��"��'�Lot size x <br /> /,J t'�ti'Jr To (,r,��v�2 r <br /> /�7n. Zc'S%�C[: �jf1�9�7� � HAd/R�L� �Z.� Lot area Sq. Ft. <br /> �Sc�:�o.J9C- O �/�^2Hc'An ��ow�s C/)C�'i��'i Numberfof1Sto�ies sq. et. <br /> i— '��rt %� Basement <br /> C/� Lc;+r?c�C/.L' A c o t . i D/ T���r /� <br /> yi1G'c �7N f�iTi� /I,� a, .:igned BY /")2t.t �u�-m-r..t� � <br /> 2�c��'D w �'(}{ `'�8 T�P <br /> Sf1£cT / � � u � b,- ]'or �2dtE ��Ef�1E'� <br /> °�X"o I.S f�o�1.Se�T V�/aC.C_ /x� T � Owncr Pn��e � r� �i s3 <br /> �:``� aD G�(.,etily . <br /> �0 ti�: tti:tr � k_'ot� -;;Tg L�..:_,C� rrT., ;.�5� or:�Y <br /> � ,.�i.,r? ;.e �one /��� i <br /> p1c:�. C.`.ec;: `lcn: °ire Zor.e �3. � <br /> i <br /> Valuation Jc-uoancy Group _ � <br /> Pemit Fee Ty�e of Construction � <br /> Plan Checl: F^_c Oc=uoant Load k <br /> Total Fe�� Du� S�:inklers Required ! <br /> . � <br /> .,�..e��.�,;�.� E�-��- �¢ a��r,t.�...�r �� ��j.��,�.. ; <br /> ._. <br />