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<br /> • • 1 , ' '; , .. . PrOYLDItlG PERHIT APPLICATYGN ' . .. �" .' `- .;,,� --
<br /> �" • •• F • � • � llppliCant To Complete Tlzis Sorm � � �� � .� ' '�� '
<br /> .. . ; . • • . .i%�j��:
<br /> ,' • • ' EL more than one building is to Ue contructed, submit a separate permit applica-
<br /> . , Eian for each buildi:ig. .1 separate permit will be issued for cach building.
<br /> " ' Oaaer �7t-i Uf,cr„e• Building Address � o7/.j o .,�,'._,,,, Q „� (sz�i.
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<br /> ' • � F.ddresa .?/.�a �j�..;.,�����+ Lot �� Slock �"R"�� �/3� '
<br /> • , City �',',�; �'� Phone ,,2.5,� -`�63y 5ubdibision (Plae) (� � � • '
<br /> ' • Pschitect/Engineer � ' C c,�.Q-te C.( • ' '
<br /> ' • °� � ", Ci:ty • Phone Idetes b Bounds (Unplatted) ' �
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<br /> �;,•: Eon�ractor t� k ia ('nNSTRi1C'TI/1N SOC. '.wp, �4e .
<br /> '' �' . , Bddress 642!•12th SG S:E. • • .
<br /> ;• . . ,k-98283 •
<br /> ' 1
<br /> , Y City Phone 33y-36`3a Duilding use ��, '`•� -'<�'
<br /> �;:� � State.License Ni:.�er ,.2.3 � U �-.�a `77� Describe S�ork to Bc Done �-v�---�2.. . .�� ~ '
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<br /> � ; '1 Expiration nat� 3 ,�, .� 76 �� � ' .+r S<.nY�c_,��t�-�__��-,,.��,_ '
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<br /> �� ' � . • SRETCki PLOT PLP!I BEI,OF7� • •_..� �' � �T �"+'� � " -���� .
<br /> — , . � " �• s � • ,
<br /> ; �, � •• . . Use o£ Duildi�ig
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<br /> t. ' - ' , ' ' . �New �] Tddition �-Repair/Remo5el
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<br /> ' �'�. � . ' � • � . _ . ' • Waluation o£ Constructian $ SD o , ' �
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<br /> -w.- . - . . .. � .._ .. � . PIAT PI.AN REQUIP,E•SF...ITS . . .
<br /> -► . - • _ e .
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<br /> • ; , . - � . • • Sz�i_cate J.ot size, nar..e of zc^_te,
<br /> , ' �i • � � ' �indieate locatior. ar.d widthJo� �
<br /> . . I • - " ;: : c �,. . • allcys, locate aroposed a:d a17.
<br /> , • ;-� , _ '_ , � ' ' � , " � existing buildiags, shc:v distances
<br /> � _, ,., � r- •a , .. 4o property lines, show distai:ees
<br /> • a _ , between buildings.
<br /> � - . ..
<br /> . . , Lot size �: '
<br /> • , . � ' ' • ' �. . Eot area 59- rt-
<br /> .• . r.. ._ . • . ... • ' � � . Size of Bldq. � Sa. Ft. .
<br /> ss • . tdumber of Stories
<br /> . :: . i ' . �. . . . . • �y.r.c:.�ert �
<br /> i.. _
<br /> 'a •,;'�• Slgned By ) --Pl�ti _
<br /> . y'_ . � . � � � .� F'O= _ t�'�.¢3
<br /> � . ' � • Qwner Ptione `� ��
<br /> ' � DO :70T {'::i?TE B£LOSI TI1I5 LI:IE-POZ CITY USE OiIL'I � ,_
<br /> : _ _ Datc Seccived � �a 1~ II�e Zone . .
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<br /> ' Plaa Check `1ur.,ber � ' Fire Zonc '
<br /> Valuation `�=�< ��� Occuoancy Grou� _�
<br /> . . . , • ^ � C
<br /> Pemit Fee �-� � � � Typc of Construction
<br /> Flan Clieck Pee Occupant L�ad
<br /> , � Total Pce Due � �- �`� Sprin).lcra Required � _ .
<br /> . • �. ;. �� ."7 � • . . o : ' . . . .
<br /> Datc Issucd __I.•� . . -
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