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: _ . { , _ . . ... � . ` _.
<br /> �� � ' ' � ' DOZLDING PERMIT APPLICATZON � � �q �"
<br /> , • �pplicant To Complete This :orm . � ��� /'o��'�„Z
<br /> - • �- . . 6/2/�s" �
<br /> ' , . • 2! nore than one building ia to be contructed, submit a separate permit applica-
<br /> ' . .. tion for each buildinq. A sepazate permit will be issued for each building.
<br /> � . ����_ ���. �i�.-CcL.c�r� lnildinq Addresa � Y;%J�� ', , �. .u,; �,�(� ...
<br /> . /
<br /> � . � �ddress _�?.i � �,�. :_., • "
<br /> _ / �- Lo! / 5" Block
<br /> .� i
<br /> CLtY �°^�= ' � Phone =; `- %�.� $- 9ubdivision Plat C , /� �' '
<br /> �' • ; � ( ) � �):', ,�..� i., � .
<br /> .
<br /> • � � � k'chitect/Engineer �<�f�y . .
<br /> _ ; - •
<br /> . v
<br /> _ '1�� .. .`Ji 'Mty • Phone lietes i Bounds (Onplatted) ' . �
<br /> . • + . • • _
<br /> ;,' Contractor e-�-_"-L.� � Sec. iVp. ' 8qe
<br /> ., .
<br /> -. � ..i• • . .
<br /> _:•.. ]ddress . . . -
<br /> .i — .
<br /> � City Phone Bnilding Ose • • •-`r-�' '
<br /> '' 'ii . •.i::� . _ , '�::t:M,_
<br /> .� ';• �.+y� State.License Nmuher � ' Describe Work to He Done ��'�'''
<br /> ; : '.I. Dcpization Dat� , �� t� • :
<br /> L1: " . ` . - • . .
<br /> SI�TCA PLOT PLAN BELOW' �
<br /> • _ j•��� • , . _ ' . . - e . • . � • { •
<br /> � IIte oE Building
<br /> . �_ , �/
<br /> •� • w.i ' . Z. �.' . • • .. :V. i'(�Hev ❑ Addition l.7 Repair/Remo&el
<br /> :� • . .� ✓\
<br /> - , i . . , '�,�� ' . - �..];;•� •Valnation of Construction 5 �,'^ �D " . .
<br /> i . • . �C7�
<br /> �-• � . ,:• � '�' lLOT PLAN REQUZREFIENTS
<br /> - ,• t , . ". �'�'�""'T. •�• . ' I Iad3cate lot size, name of streets. . �
<br /> " } •indicate location and width of
<br /> ' ' •' �. � ' � .y� ' �' . := : � alleys, locate pronosed and all
<br /> • '1 ,;��} � - . •, ,. •� � • . - ° ` �/ lxisting buildiags, show distances �
<br /> , , : a� ' �:^z"•'. 7-•� • �: . i� 1' .
<br /> !�. � 1�6'�erty lines, show distances
<br /> r ' � . ' • �t ;: between buildings. . '
<br /> : �
<br /> � • -- � . . ,
<br /> - . :'. , ,. .. . ., ' ` 1 I.ot size X
<br /> ; _ � �. • �:• Lot area
<br /> ... ,. . � 2,.,1 ' t'�.�+ . � Sq. Ft.
<br /> • e.. - � ' • ° Size of Bldq. Sq. Ft.
<br /> `� � , � � � liumber of Stories •
<br /> .j. � :: • 1• : . .• . . � . . ' , �BaSCment
<br /> ,� .:�- . . . �. (I� . l. , _+- .
<br /> + = • � : �Siqned By _ �-�+ :�: '; -�: . :�
<br /> • '• • . ' • . For C' • .
<br /> . . '� • � ��� •.. � , Owner Phone -�.Sr_ �� � S �.
<br /> , . . . . • _ . � . . • ...,
<br /> -. '. , � DO NOT SS:iIT� ELO[�7 THIS L2:]E-r^OR CITY USE O[tL't '
<br /> -- — Date Seceived C-r J� ' vice Zone �
<br /> ' Plan.CSeck :Iurber �_ -
<br /> . Fire 2onc
<br /> Valnation �Q��. �'- Occuoancy Group � •
<br /> , Petvit' Fee "'�J � � Type of Construction ' .
<br /> . ,' ' Plan Check Fee � T- Occupant' Load • . • '
<br /> . , • , 3bta1 Fee Uue ✓� Sprinklcrs Required ' ,
<br /> ' , .. ' /, . ;
<br /> Daie Issued ' J ' • • ' , • , _ . :
<br /> ' .•• , . , . . ' , , . .. �, ' . . . . � 7:
<br /> , . • • . . . . , • • ' . ': . � .
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