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_ � � . . • . ' � ' DOILDING PERMIT APPLICATION ' ' ' '. � �yf'�
<br /> , • applicant To Complete This :orm � . ������`��
<br /> . � , � a�
<br /> � Ii �ore than one buildinq ie to be contructed, submit a separate permit applica�s
<br /> �• .'"; tion for each buildinq. 1► separate permit will be issued for each building.
<br /> . �J � / ,
<br /> �'� / ,
<br /> . � � QUO!! .:J'Gj.t2y .��'R�i.1-z'�-- lniY3inq Addz. as �!..)G/ `f�/.,.<,¢'�.�' ��r✓. .
<br /> � y � . — -
<br /> . + 3ddress �j)'C / ..��/�.'z.�:�? Lot Block ' -
<br /> •''„• ;�� City i�i-r-�t`2�" Phone i�i:7- C33 7 Sabdivision (Plat) .
<br /> . � .
<br /> � � = �x'chitect/Enqineer � -
<br /> - . . � .
<br /> _ •:��� . .`_'1 City . Phone ltetes i Bounds (Unplatted) "
<br /> :�' Oontractor �`�a-�`�:=i J���--w- . Sec. iSrp'--, gqe
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<br /> �;•. 3ddress ,�s y's c c'���.,«�„ ,.n-� . ,
<br /> :? .=�� . •.
<br /> i CiM �s,!,..:u-,...r � Phone .�� b'-Gc'.3 "� Snildinq IIse . . �::,::i- .
<br /> =�'.>.:.
<br /> ' � ,h} , •�::: . .:. , . ....rt.�
<br /> �• ':. �.ty# State,Eicense :tumber X.1�Y d ( / ��'G� Describe Work to Be Done '�'�" ~ . "
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<br /> • • ';i. iration Dat� / /� � ' • .
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<br /> , � . /- - 7`� .��.� v„ �zGt�� .�:.��il�� . _
<br /> 1: ,� . �• • . _ .
<br /> SRfiTCfi PLOT PLAN BEZAf�' �
<br /> • .j.�,� , • . ._ , . . . . . � IIse oE Buildinq ; . ..
<br /> .�
<br /> , . .. • , . . . ,
<br /> s , •�Hev ❑ Addition [�,Repair/Remouel���,c.
<br /> . . � .{ ' • . .. . . � • • i 7 .
<br /> ' , i . - ' ' . , - ' �.. ' . •Valnation of Construction S //�G��' .
<br /> e � • _.
<br /> ,�,r, � .. . ,:.• . . , . •• . . . PLOT PLAN REQUIREMENTS _ . �
<br /> � , . . � . .� . . . . �.+ .
<br /> � �• .1 , ' , . : ' , •. � • ' Iadicate lot size, name of streets, �
<br /> • " � ' •indicate location and width of
<br /> . '•" alleys, locate prooc�ed and all
<br /> ..�'y� , � .� � Y. , _ � 1•...:L . . , -
<br /> • '' .;'� � • . •, ' � ` • . - ' ' � lxisting buildings . show distances �
<br /> _ • �;t ' �. ••�^'"�' "'�9 : : ' • '� ' ' • . !o praperty lines, show distances
<br /> : . . . � . • • bet�reen buildings. .
<br /> ' . . ' -• . ' . . . ,
<br /> . ;•, _ �, � , ' , I.ot size X
<br /> .•i- s , . • Lot area Sq. Ft.
<br /> � r.: �= �• ". Size of Bldq. Sq. Ft.
<br /> �s .. .
<br /> • , „ . tiumber of Stories
<br /> �% • � ' • . - . Basement i ,�
<br /> �+r•,_ . . � .. � . Signed By - :.-./C-� \ � �._�� ' -.
<br /> _ i � . . . � For ` �` . .
<br /> . . ' �. ' ' Owner Phone
<br /> '. � � '. DO NOT k:2ITE B5LOt9 THIS LI:IE-iOR CITY USE OtIL'i `
<br /> --• .— Date Seceived � 3J � � ' IIce 2one
<br /> ' , Plan•Chec� :7ur.ber Fire 2one -
<br /> Valnation /�0� '��,� Oceuoancy Grou� �
<br /> , . Pemit' Fee �P• � ' Type of Construction • .
<br /> . , ' Plan Check Fec ` Occupant' Load . � •
<br /> . � ..
<br /> . Sotal Fee Due S�O- ' Sprinklers Required ' ' ,
<br /> � � Date Issued ' 5�36 7�� • '� ' ' � :
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