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<br /> __ � : 9USLDSNG PERMZT APPLICATZON ' ' �
<br /> ' . ;' , " , ; Ilpplicant To Complete This Sorm � �,�
<br /> • • Z! more than one building is to be contructed, submit a separate pe.cmit applica- .
<br /> . !1on for each buildin:�. .1 separate permit will 6c issued far each buildang.
<br /> � ; � Omer F � 1��c1f !)f•:- /_ /ii= Buildinq Address � '�-` ��i" !�r%4.�'v_^-%-�.;,_� :
<br /> , � ' . 14ddress � Y� � l=�r.kT �-7- /) -v�= Let Slock � .
<br /> � City /�i��/,>i-;� Phone � S'S- G o�� Subdibision (Plat) :
<br /> _ � • llrchitect/Engineer L>�./i /� ;Q N �[ �_� '
<br /> _ � '• � ��=� City S �'o /,�pn�� Phone Scy_��.,-��izz Hetes i Houads (Unplatted) �
<br /> •. :, Contractor /�1 C" C- � r�.= C< �, ,T Sec. �,,p. gqe �
<br /> _ - ' � 1�dICS6 �� ��/7 � ., � N ! S � � ' ' .
<br /> �!, �tY NGiUn/� �' Phone jiy -']�i'3 Buildinq Use /t'Apir� /t'/=Pni;7� 5�b_t'�?=��...
<br /> - ;; State License Ncmber 1 �3 c i 'Jy?� Describe Work to Be Done `.�i I �1 i i= ` �'' .
<br /> , _ . . • ;i bcpiratian Dat� /C �/3� 7� '
<br /> , ,
<br /> . • '
<br /> ' �~ � SICETCH PL�T PLAN BELOS4' • -
<br /> . ' I . .ii' ' . .
<br /> : { 3�'� . Dse of Building '
<br /> !� ` , '--� . •�� ---.� — . . . � - �New ❑ Addition ❑ Repair/Remo;;el
<br /> , � . ,
<br /> � � � ,• Valuation of Construction $ ,� p c, >r � '
<br /> • Y�� ' . . . . i . .
<br /> "` ' � . . . ^ . P7AT PLAN REQUIR&�1ENTS
<br /> ,�. . . . . , . . . , .
<br /> . . I�, .
<br /> . . ' ' -_ ----'I-=-----=-„ ' ' Indicate lot size, nane of stre�ts,
<br /> _ �c� ' ,_ ' ' indicate location ar.d ai3th of
<br /> . : . allcys, locate pr000sed and alJ.
<br /> :�.( : existing buildings, sho.+ distances l
<br /> • 1 " '! . - • to property lines, show distances
<br /> . .
<br /> � • between buildings.
<br /> � r - , ��
<br /> . . I.�t size x -' l '}C s�
<br /> �
<br /> . . . Lut area /u �yC " � Sq, rt.
<br /> • .:. - ----%r---t--- ` -- Size of Bldg.' v�'Y 9c - z:,c Sa. Ft.
<br /> � � , ���c • Numbcr of stories / + %� a ti.... 1_
<br /> � ��; � i. , . � Basement
<br /> :.. . -
<br /> -� . - Signed Hy �/�,..., C_�;,.4'_�(�
<br /> , ;
<br /> � - . � � For t_�,:_.i �: �:: �
<br /> Uwner Phone �,;v 72.• ;
<br /> . _ DO AO': SC:2ITi B�LOH iHIS LI:IE-POR CITY ❑SB Oi7I.1 �
<br /> Aate 3:�ceived /7 �S" Uce Zon�
<br /> ' Plan C:�eck CJu:,ber _�j'Zy�' Fire Zone ' -
<br /> �9��D• � '
<br /> 'valvation Occuaancy Group
<br /> Peznit Fee . Typc of Construction
<br /> Plan t:heck Fee Occupant Load
<br /> , � Total Fee Due Sprinkler.^, Required �
<br /> Datc Issued � '. , _
<br /> . . - �
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