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<br /> � 1 � ' � BOZLDIHG PEfiMIT AFPLICA�IOY ,.'•. � ; ,.
<br /> - ' " j ' , , : Applicant To Completc This :orm � , .y
<br /> .. . � . , '. • � . �. .
<br /> , ' • I1 more than one buildinq is to be contructed, su6mit a separate per.nit applica- •
<br /> .• : tlon for cach buildin�. �1 separate permit will bc issucd for cach building.
<br /> • ,� ��r -.! o Y h ,r /� .� ,� i Suildinq Address a H c 7 �'v�'rr r- !`T�t�t�
<br /> � -� i �e �� �b
<br /> , � , lddresa �f'oc J>n v i n' /7 n i��r LOl7J-1 lvi ��'c la Hlock l0 04 �
<br /> . City �.r- n F r r Phone j S;5' -7o e 7 Subdibision (Plat) �'.��-��i� ����
<br /> t • �rchitect/Enqineer � • • � • � •
<br /> _ !ti � . .`.'j City • Phone Hetes Z Bounds (Unplatted) ' •
<br /> '' ' • j ' • ' -
<br /> . ;,�, Ctratractor �o i` � ,_(',f ' Sec. R e �
<br /> _ . ..� . �'P• 4
<br /> -�. %• : �• J�ddzess ' ' • •
<br /> .. �� City Phone Buildinq Use ,L� �,, i= . . �;; :` :�
<br /> ;.. �•.I'
<br /> .}1 • •.,:, ' • ' • - • ..�. - . ,..
<br /> �} � State.License Nuaber Describe Work to Be Done _l,v r,��ro 2�'�
<br /> . � � . . . , ,
<br /> : : �I Ezpiration Dat� � j�j CA-� c r� i3 � -• 5h F_ F_ T /�co K � /✓i:��in5
<br /> _'; . . . ' �Op�7- ,QJF_ 2 C3..o<Ix F.u.t,�TNiI a .V '
<br /> � SRETC}i PLOT PT..Li BELO[Z' Re c .�i � >l u .�f r' U(�5 TA//?S /3�+I`I{
<br /> _ . . � • .. .
<br /> �J', . ,., . , . • ;
<br /> Ose of Buildiriq
<br /> � • ='� T{r;tia ✓:r c.v/-� �. i�: . il�-. .•�3'i;�'Fc•1�u.. � •
<br /> a• • , . , � �New ❑ Addition �.Repair/Remo:iel
<br /> • . � .i � . . . . ' i� .
<br /> �• . " ' '�• . � • j' • Valuation of Construction $ � � � ��'� •
<br /> '• . . . . .. . I . •
<br /> .�• . + - ' : . . . .. - ' • PIAT PLAN R£QUI?2E�IE:ITS .
<br /> y . � . . •
<br /> � • . � • � � � � • . �'�
<br /> :. � • • ' ' • , • . • • ' Sndicate lot size, nane o£ streets,
<br /> • . ..'� ' • ..' . w . • ' ' •indicate locatioa and wicth o: �
<br /> . �•,� _ . alleys, locate �roposed a.-.d all .
<br /> ' `'�1 • ' � existing builci:qs, shc:a distances
<br /> . i ? ' •�-" '" " '! : ' • •~'•' ' • • to property lines, show distances
<br /> , � � , • �: � . � ' , � - . betxeen buildings. .
<br /> . . ` . , . . -• ' • . .
<br /> . • • ' • ' . • � , . Lot size x � •
<br /> . �
<br /> •• • � • • • ' • • . Lot area � Sa. Ft.
<br /> .
<br /> r, = . . , � ' Size of Bldg. Sa. Ft.
<br /> � ' � , • • ' ' Number of Stories
<br /> . • . :. . j . • . . .. • - $asement � .
<br /> '��,• ' • . Signed By �.f�.�,F-� ',�' /� <<-. '
<br /> . . . ��7 .`_'_�
<br /> • i�_ � � . . ' • • �� � For
<br /> ,' � . Owncr Phone
<br /> .. . DO :IOT IC:tIT.*. 9�LOI7 THIS LI:IE-20R CITY USE O21L'L � - .
<br /> .. .. • ' / . � • � ' � .
<br /> Date !:eceived �( 7 1 � IIce• 2one �
<br /> ' Ylan C:icc;; :Iur.ber -- ' Fire 2onc '
<br /> � )
<br /> � .Valuation ���� C Occuoancy Crou�
<br /> � � � ' C� Ci, .
<br /> Pcmit Fcc �7�• ' � Typc of Construction
<br /> Plan Check Fce �— Occupant Load •
<br /> ��C% .
<br /> . � 1Uta1 Fcc Due 3? �- Sprinklcr� Required '
<br /> . Date Issucd l Z�/%/7 f , . . • • . . . . _
<br /> , • '-7-T-- " � � .
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