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<br /> - ; • � llpplicant To Complete This :orm •
<br /> _ . j . • • . � � `� �,���7�
<br /> , • � If aore than one buildinq is to be contructed, submit a separate pe�it appLica-
<br /> . . tion for each buildin�. A separate permit will bc issued for each building.
<br /> . � ' Owaer C�.io�/ r� /I i//, P�`_ Suildinq nddness ��..2/�� ,�c�,� �a..��+ ; .
<br /> i . � '
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<br /> , • . Lddress �r-�/ � -� �«il� ,,�l Lot1'{ -i 15 92ock �//, ttl-�-e�,_ � .
<br /> '� . . �ty /—✓%rc' /� Phone Subdi4ision (Plat) �dr_,�-�/� /_:r.:,:4 L; •�s�l!
<br /> � . �
<br /> _ • ixchitect/Enqineer • . , � ,
<br /> _ �: . ='� �tY • Phone _ Hetes t Bounds (Unplatted) ' •
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<br /> � ,-,•; Cantractor �i�.-�.' �,�. ,;� ��Ncc„Y� �.,•h Sec. ' ..
<br /> _ .., . 7tJP• Rge
<br /> _ ;, . �• lddress ! ,/r� �S�c-✓e�>s � . . . . �
<br /> � '.•t atY Phone �sy-3C-;13 Bnilding Use . . �..� ' .
<br /> -? .
<br /> •41 . .. ' � - � ,.•
<br /> -� ' �" � State License Ncr�ber .�z3 -�� / -.���f 5 Descrihe Work to Be Done ,f c�-�1 u=' � +. ��* �
<br /> r� .
<br /> : : �I Erpiration Dat� 'j� / .� 7 � •1(. L� ,/ • / / •.
<br /> , `�'��� '�7crL �;,...,-0 .^, -6lshlu// Si7i�rq/t_s
<br /> �' � • • SRETCH PLOT PL.1N BELOSQ' - •5 f• ��E�/i�s - � / w,�>S �,c '
<br /> � . j _� - • . . . : , � IIse of Buildirig � '
<br /> � .' _
<br /> �� : • , . . .,. • LINew ❑ Addition f$�Repair/Remo�el
<br /> - • `.i' � . . • ' . , t .
<br /> �' � ' � . � • ;' "• . oaluation of Construction $ ��f�,� c`�.
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<br /> , .� . • I . -
<br /> ""`� .� �� - � '�. � .. - �� PIAT PLAN REQUI?tE�L:ITS . .
<br /> --•. • . _ . .. . . , . � . . . :3 -
<br /> ` . _ , . :
<br /> � " � ' ' ' ' ' ' Indicate lot size, nane of streets, . �
<br /> - � y � � � ' ' �3ndicate location and width o�
<br /> ' � ' '•'� � = • • alleys, locate �roposed ar.d a11 �
<br /> ' , i � ..•*-:- L V • . • .`,' •' . • existing bsildiaqs, sho:v distances
<br /> � . .. . • • . to property lines, show distances
<br /> � . �. � ' e, . _ . betWeen buildings. .
<br /> : .f • ' . _ . . .. . . . , - ' : Zot size X ' . ' •
<br /> . � , s . � . . .. . .
<br /> . � . •� � � . ' . . Lot area Sq. Ft.
<br /> • r.. ' - . ` ,:_ • . Size of Blzg. Sa. Ft.
<br /> `j � • ' " Number of Stories
<br /> � •: - � � ' '� � Basement
<br /> .r. _ . • • . ^
<br /> , -- • '
<br /> �; . ' . . . . . Signed By � �-.����(� . •
<br /> . ;. _ . . . , ,�
<br /> .. _ . . . . . Eor
<br /> • ' . Owner Phone
<br /> ..' � DO :IO': ttiZT_TE B�LOtl THZS LZ:dE-POR CITY IIS Oi7L'! ' � �
<br /> � Date �aceived ��/��/`� � � ' U�e• Zone • '
<br /> • - - —� .
<br /> ' Pian Check :lur.ber ' ' Fire Zone ' �
<br /> valuation � �,�'C'.? �--� ' '
<br /> , . . Q^cunancy Grov� .
<br /> Pemit Fee �. b'� `' ' � � .
<br /> Typc of Construc�ioit
<br /> Plan Check Fee — � ' Occupant Load •
<br /> . . L,`. . .
<br /> . � Total Fec Due c' � ' f Sprinklcrs R�uired ' � ',
<br /> ' � —
<br /> Datc Issucd ' �/�/ `• �� J ' . • ; ', ' ' '
<br /> � � .� . �... . �---��� . • • .. • ';. . : '• . . . ' • .
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