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<br /> • �OILDINC PEAMIT APPLICATION . �. �' 1C L '
<br /> - . . � � • • � • �pplicant To Complete This =orm • {' ��'����
<br /> - i . ' /� f
<br /> � � Yf pore than one building is to be contructed, submit a separate pezmit applicad�l-`=
<br /> �•• �.• '; tioa for each buildinq. 11 separate permit will bc issued far each builc(ing.
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<br /> � ' prper i?,-f•rn,� . .�rr4L � Huilding Address � ll')C',' ��'i•� . �' t��
<br /> ; i � ✓
<br /> ' , y �ddress �/)C / ��/�z;z.l::-? Lot Block � _
<br /> ' '� City c�`-�-�-'��Y, Phone-'.i,•>'- G 3'3 7 3ubdivision (Plat) • ,
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<br /> ' ' ' �rchitect/Engineer , �
<br /> _ •_+�� ...`.'� City • Phone lietes i Bounds (Unplatted) ' _ �
<br /> . ;,� Cantractor (°�.e��-i I��L��..�-•��- Sec• �+p' � R4e . .
<br /> L. .i'.t-�' �r!'S5 r�u3 �' L�.���-�LlI � •�::/ . � ' . . ` .• '.
<br /> . f City ', %� _ �^ Phone •��� Bnilding Use � ' =����
<br /> �. .� �� -�`,.'t.
<br /> ': �•hj , •."i:.:, ., . '- •�'- .:. . . - "�" ..
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<br /> • • �. 'y State.bicense Nmnber �'.�:5' � ( / ���G y• Describe Work to Se Done _ .
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<br /> . . :�. y:piration DatB // - /� - 7`� _ • i • -Gcy" ,{�,�i/=t-.n _, ' :.
<br /> . P —
<br /> ��� �!!!. ' . = SRETCfi PLOT PLAN BELO[i' • , ; .
<br /> " ' .j���� • , .. : • � IIse of Suildinq .
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<br /> �" j . • , . : ' .,_ • []gev ❑ Addition Q Repair/RemoGel
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<br /> ' ' "*•i ' : ` ' , • •, , . . . �.•"• •Valnation of Construction $ // , �'�'� '.
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<br /> o . • . . . � . % • . ' PLOT PLAN REQUIRF.23ENTS = ' '
<br /> �,,,. ! �� . .: . � � . . . °.� , �
<br /> .4. •. . . , . . ...e • . ' . .
<br /> � � ' ' Indicate lot size, name of streets,
<br /> •' ! � ' . �.�-� • , - • +. •indicate location anc width of
<br /> ' , .` �; � • . .. " .y:: �• ' . `" ;4..:: �' • alleys, locate pr000sed and all ' �
<br /> ,, ;:� - ; , • ." . , . .� ' � existing buildings, shoia distances
<br /> � � � � `w; :'-. ...,e • . i • ' to property lines, show distances
<br /> - � 't . �� � � • • . . betrteen bu_ldings. • :
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<br /> � � ' • � . � � . . ' . . �=.Ot S1Z0 __ X
<br /> , ��• '�. � . . ' � � ' . .
<br /> a . .. . • I.ot area Sq. Ft.
<br /> � ��. ': ' • Size of Bldq. Sq. Ft.
<br /> •',j r: .. ' . •. �Tumber of Stories-- - —
<br /> • :: . � ' • , • . • , . Basement � -- � ; � _
<br /> , r .�.- , . , . • Signed By - --��c \ • {••_� � ' 'L
<br /> ~ � . .. . . � ' , . • L a «r� . .
<br /> . ; , � :• . . , For
<br /> ' , ' • . . . ' Owner Phone
<br /> - � � • DO NOT h':22TE BSLOI•7 THIS LIVE-FOR CITY USE otri� � � � �
<br /> --• Date Seceived � 3� \ ' � Tice Zone •
<br /> ' Plan•Cyec� .7ucber Fire 2one
<br /> Valnation �����a�- Occuoancy Grou� •
<br /> ' � Ycmit' Fee �CP- � � . Type of Construction _ � •
<br /> , ,' ' Plan Check Fee Occupant' Load • ,
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<br /> , .;� Sbtal Fee Due S �D' ' Sprinklezs Required •
<br /> • • 30 /7j�. .. . : :
<br /> � � Datc Zssued � s ' ' • , • � • �' ' • ' �'
<br /> s .• . . . . . � ',�:,. ' , ' , . . . :;..
<br /> . : ' ' ' • . . • ' : , • . • . • • ' .,• • ' . �
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<br /> . _.- -.� ..�_..-_..._. ._.�._.....__. .
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