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_ ,• . • : ! �. . , . • � DOILDINC PERMIT APPLICATION � ' . . , , •.• • .. .• ' , •°.��
<br />! . �pplicant To Complete This :orm � '? /� ��
<br />' • i ' • • ��,�c�,(�`/ r_/
<br />,� If mre than one buildinq ia to be contrueted, submit a separate permit applic��y7f
<br />' ., tion for each buildinq. 11 separate permit will be issued for each building.
<br />:�' Ovner �S-C l�l. lSi � 1' 1 v� �C Bnildinq Address � 22) 3 v'� f��i �'o I�� ::
<br />'. .: aaa=e5s Z`�-2� C,3�.�i/ r.oc 22 ��."� aio�x 1'Z .
<br />�� Ctty �vV�'`.�'i� Phone 2S2-g�5� 3ubdivi�ion (Plat) p\1`t�Nv�S�' :
<br />... � ' 34Z-4� � •
<br />• ' � �rchitect/Engineer CP�o,,:,..�.� a.� .
<br />_`,'L+��..`."� City • Ptone Metes i Bounds (Unplatted) _ '
<br />_ ..j . , . _
<br />;,• Contractor `���L_� Seo. 'it�p. ' Rqe '
<br />.� . , ,
<br />_ ; . .
<br />`: .;... �• �ddress . . . .
<br />.i .
<br />�, Ci Phane euildin use ' �°' �� �
<br />h' 4 ..� _,,. >
<br />....•:�i .: �.:� � . . ,,,:;'';-
<br />"` State License Number Describe Work to Be Done '`
<br />: � yj. L�iration Dat� ' pl.v=iti��vt ���-�-f-= w� (Z�1 �� �'
<br />'� h 4i
<br />: ' . '� . - � S1�TCFi PLOT PLAN BEI,Oti' • t`oo �. N10 V 6 �y,T'V'MO�- ��t"% i .
<br />.' .. ? ,� ' . . . .:. - . . . . . . . - . .
<br />� Ose of Buildinq �����13��L� �
<br />♦ i � . ' . •(]gew ❑ Addition ltlxApair/RemoGel
<br />. ' i* EZ�i' .
<br />� • } ' .i' � , . ' • � � Valuation of Construction S � ta; ".� ,
<br />i. - • . r.. . .
<br />: • . . : . . . .
<br />.�. .. . ..' � � ^ ' PLOT PLAN REQUIREFIENTS � .
<br />,� • . . , . . . . . � • • , . - �.. .
<br />.. Iadicate lot size, name of st:-eets,
<br />, !. • ' � • ' � •;ndicate location and width of.
<br />• ' �� .� �. ' � • ; �� �.� `+�; ' _ � : = � • illeys, locate ?ronosed and ail � �
<br />'��" � • - - '� ' lXisting buildings, show distances
<br />_ ., .', T.. _'_ � � � . .� }.
<br />3. i ' -•• . . • .' • • • to property lines, show distances
<br />; . , � , . betueen buildings. .
<br />. . �. i � ' • � . • ' -- . � . . , .
<br />• . �. , • . 7.ot size x
<br />. .�, ,. .
<br />... . s � , ' � . . '�. . � 7.or area Sq. Ft.
<br />� �; = � � � � � • '. - . Size of Bldg. Sq. Ft.
<br />'1 . , " . „ Humber of Stories �
<br />:: ,� . • . ' , Basement
<br />'�._ . p , �;n n,,
<br />'� _���� . . Signed By �CJ�.� � YV�-1M-
<br />_ � � , . . � For ,
<br />. . . . . . . �- . . � � Owner Phone �l.'.T 'L- a-075p
<br />. • • . 34.2- 9G�',�i �
<br />�� �� ' DO NOT St:i2T* BELOI�7 TH25 LI:7E-FOR CITY USE Oi7LY ` .
<br />-� •-. Date �eceived S/ C(,z /';5 ' IIce 2one
<br />. . �'T-
<br />' P1an.C:�eck :7urber " Fire Zone '
<br />�'
<br />Valnation ^'��':.c:', ) ''`" Occuaancy Group
<br />; . 8emiti Fee �ls c_'�''� • `�-� -- 'lj�pe of Construction ' .
<br />. .' ' Plan Check Fee " "" Occupant Load . �
<br />. � Total Fee Due G� (��' � ' ' Sprinklers Required ' _ ' .
<br />' Datc Issued ' '� Z Z • A . . ' . . . . - .
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