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<br /> � FJilZLDIIdG PERIdIT API'LICnT70IJ � •�;( lIS'��
<br /> � �' � ' , , : Applic�nt To Co:npleLc Thi� Sorm , ' ,�, � ,
<br /> .. ; . � �• �/���,,
<br /> • • zf norc th�n onc building is to bc contructcd, su6mit n �eparatc peimit apnlica-
<br /> � . , tiOn for cach 6uildii��. .1 se�aratc permit will bc i:::ucd Lor car.h buil.ding, ,
<br /> . � � trmer fJ/•5 (.9 „,� ,� Pr�� �� lluilding ndrires�
<br /> �
<br /> ' � . Eddress fj'UZ Lc�rh.,..! Lnt Dlock '
<br /> CiCy L�p, zf� Phonc Subdivzsion (Plat) � ` . '
<br /> ' • L-rchitect/�ngineer � . .
<br /> '"� City � Phone IS�L-es 6 Lound:: (Unplatted) -
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<br /> • :,'. Cantractor 57` r' n� r ��;-oa.,�ii<t7� Co Sec. 2t�._ � Rge ..
<br /> . ...� �. . .
<br /> �' %' '. 3�dress /3os /�i.r%/.sa.� ' •
<br /> •' ;�tY �-fier-a7`f Phone 3S3 -/2.y3" 'Du9.lding Dse �•� : 1
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<br /> �';� � Stztc.License ticnbcr ZZZ _��_ q�,�� � Describe S7or1: to T3e Done fj�` �
<br /> � : �i �piration Date S� ' Gj-- y � ' ��� �� � �� '
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<br /> � �� ' '� . , •� SFETCIi PL'OT PI.T,?i ?IELGf•7' • �/,�•.7�a,�c /� ./, t._,_��`�'`' ' <t �.,.L (�-(,..�,(y"
<br /> , .,i . . . .' • , , , , 17se of. Buildir.g . . �
<br /> _L' � . � .�� , . : n2rew ❑ Addition � Repair/Remo;<el
<br /> ` e� _ ' � � � • . • • •�'a2uation of Construction $ � `� "
<br /> . . ,, �s0'
<br /> a . . . . . . . . .
<br /> • � . . . . � ::PTAT PI.A2d R£QUITtF�'�.,.TS .
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<br /> _ ' ' ' ' - . ' ' � ' Indicate lot size, nane nf street_,
<br /> �� ' ' ' • - . ' rsndicatc locat:on ar.d ;•;idth o�
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<br /> ' � . ' _ �� � �• . • ' �allc�•s, 'locatc oroposed ..;:c all � .
<br /> ' ','�� � � .e5;icting builcings shem'dist�^ces '
<br /> . .- '� ' ...' - - .'o , . '� = . . -Lu proper:y lines, ,si;ow distances
<br /> . ' ' s • - _ bct�aecn builciings.
<br /> � � , _
<br /> T • . ' . ; - Iaot �ize x
<br /> ' . ..- ' . � , Lot- area Sq. Pi:.
<br /> .•.. - • � ' � . �Size of IIlcg. Sq. Ft.
<br /> ` + . ' • IiumUer of Stories
<br /> • �; . � , . � � .IIase:nent �
<br /> r'.. . . ' , . _'_
<br /> -�. '` ' Signcd By
<br /> . : . • ' Por .
<br /> ' Ocancr Phonc —
<br /> .. � � DO N0: Si:t?T� T�?:A'.7 THIS LS:•L?-POR Ci7'Y ❑Sli Ot;L'1 ' �
<br /> Datc Seccived � Uce 7.on�
<br /> ' Plan CSec1; :7ur..bcr ' ' FiLc Zoac �
<br /> ' l'aluation � _ Ocr.troancy Grou� __
<br /> � Fci�it: I'cc � � � Tyr�e o£ Constructibn �
<br /> Plan Chec): Cee _ Occui'�:�nL- I�oad • ` ^
<br /> . : Sotal F'ca Due ` :;prir,l:lcr� R.�quirc�d ' `_ .
<br /> b:b: T_aucd � . . , � • . • � � . .
<br /> � - . . " -• ' . � , • � �.�.,i'� ' . ,.
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