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_. ' ; ' � � � sQILDING PERMIT APPLICATION . � ��7 Z <br /> - ' j ' , �pplicant To Complete This ?orm f / C� �•I <br /> , • `' If more than one buildin is to be contructed, submit a se arate �///�' <br /> 4 p permit applica- <br /> tion for each buildinq. .1�eparate permit will be issued for each buildinq.o <br /> ��� 0vner `'�J�!-��Yr�uti� ,`�G�if//"'; Building Address ��' J/i'�,/�O�yj�f,,l,� : <br /> . ' , �ddress �yJ� ���1���N,l/•'l Lot% 2S Block � �J;/,f:• ,�G , <br /> City �Phone �S� = ��7 �Subdivision (Blat) : . <br /> � lrchitect/Enqineer � . <br /> `":� City Phore Netes i Bound. (Unplatted) ' <br /> _ � <br /> :,' Contractoz • Sec. 1+vp. Rge . <br /> .. � 3ddress • . ' , . . <br /> •'' City Phone Building Use • - � ' <br /> :a'. <br /> {.1 . . .,:, . ,. , :: <br /> ••. r� State.License Number Describe Work to Be Oone ���1�{JJ//f.,���.��, <br /> • . ,I L=pization Dat� ' <br /> :1: ." ' . SICETCH PLOT PLAN BELOf9� � • . <br /> . , : 1 / ��, n� . . Ose of Buildinq ' <br /> • � � � . . , , � �New ❑ Addition Q Repair/Reir,oc;el . � <br /> , . CG����Zj�-_-.__ . . � �--' _ . <br /> ' � . � Oaluation of Construction $ ��` � <br /> �.... . � � Q ^ PI.OT PLAN RE4UIRESSENTS <br /> � . ��,� i ' � � <br /> i • �S' ' Indicate lot size, nane of streets, <br /> � . �� h--�- ind3cate location and width o: <br /> � . � �� _� , _ _ � alleys, ?ocate orogosed and all � � <br /> • :''j _ �� . _-}r- = � , Cxisting buildinqs, show distanres <br /> , 'I =�=- v �� � � ."�'-� �tN �• to property lines, show distances <br /> ' �j_,�4.'tF* betaeen buildings. <br /> � � • Lot size x <br /> � " ` - -'t�.C�r�,i� w��.. �• Lot area Gt'. � Sq. Ft. <br /> `'_. ._ r. = I � . Size of Bld4• Sa. Ft. � � <br /> � • � • Number of Stories <br /> • .: . = Basement <br /> '�r �� /� . Signed BY ��.�/it'�/.c��� <br /> . i, _ _ . ' �! For �.�G�fl,� <br /> /r - <br /> � Owner Phone <br /> � DO NO'P S{ZIT� B2LOS'! THIS LINE-POR CSTY USE OiIL'i <br /> . Date ^eceived �. / ' 7�' A�e Zone � <br /> ' Plan Check :7urber � � Fite Zone ' � <br /> Valuation /(�J C� '—' Occuoancy Grou� <br /> Pemit Fee � , O � Type of Construction <br /> 81an Check Fee —'�~ Occupant Load <br /> , � Sbta1 Fee Dae J• C/ � Sprinklers Required <br /> • � . <br /> Date Issued /,` 7� , , _ • <br />