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:"' •• •• t . � � � DOILDZNC ?EFiltIT APPLICA�ION � ' �
<br /> .. • ' �?Plicant To m t`� . • . . T
<br /> i ' • ' Complete This :or �" ••�•�
<br /> � ' � Y1 more than one buildinq is to 6e contructed, submit a separahe �ermit .applica- i �.
<br /> , • . tion for each buildin f
<br /> _ 3• .l separate permit vill be issucd for each buildinq,
<br /> • � Ovner - ,/, G - ' .
<br /> , . � � Building Address �
<br /> �. ' . Eddress i �.' _ ,> ���- , .. - , .
<br /> C'.t r" Lot :� >7���_ Block „ _
<br /> Y ,_,.,,,,�_. Phone • . ., . —_-_�__'"'?'-
<br /> . Subdi4ision (Plat) /,
<br /> � � r �
<br /> _ ' r�Yliilect/Enqineer ' , �'--=� �
<br /> . :, ' _.I City � ------ • .
<br /> ' - , '"j �_______Phone Metes s Dounds (Unplatted) •
<br /> �:�' Ccr�tractor ��-�Z_� ' • ------ �
<br /> _ ; ' ' ' Sec. �. �g� , -
<br /> , '� 1L'�ress � , . ---.-_
<br /> . �l; City Phone •
<br /> •;�; �- IIuilding IJse v ' �
<br /> ' ' �" Stztc Licensc Nc�bcr � — �, . ��.�
<br /> �I � • . ..,r..
<br /> - • . —�__ I3escribe Worl; to Be �Done� • - ���"C�
<br /> ; �I Ezpiration DatB �, •� .
<br /> �L .y, •; . .
<br /> �� � , ' SRETC}i PLOT PL;�I BELOIJ. • ' ' � . .
<br /> ' • • i ' • «. .: '. .: . .. ,d� '
<br /> .. .
<br /> . .� . ' • � � • • ,
<br /> Qse of Buildirig
<br /> `� . •. ,. .r . .• . ,
<br /> �. : _ , • •t . •..
<br /> � �--"" ` - -- ' n27ew ❑ Addition
<br /> ' •? Q Repair/Remo�el
<br /> .. . . ��. .
<br /> ' ' • • �' �'ulaation of Construction $_�_ • .
<br /> �,.,• . ` : ' . .- _ .
<br /> � . ,. � . . .. � . . . . • ' PIAT PLAN REQUI��L:7TS � .
<br /> , � : . � � . . . - v
<br /> _ .• � . . , i c ..i .
<br /> . . 9 . . . . � ' � � ij1CI1Ci.�C ZC� S1:.C� i1�^C O�
<br /> • � • " ' " •indicatc locati `��""
<br /> o� and wict!�'o..
<br /> ' �" ' • •'' ` - -' � � ' al2cys, locatc �roposed and all
<br /> . : �. ... . - ._ .a � • ', j• ., •";: ' existing build.iaqs. sho:a dstances
<br /> , ; , •.e . � • �to property lines, show distances
<br /> . . � . • _, ' . betNeen buiJ.dings. .
<br /> � ...� � , , � " '. � , I�rt size X
<br /> . -� � ' , . � �. Z.ot arca � Sq. Ft.
<br /> � ��i �f j � • '� � � � . Sizc of Hldg. Sa. Ft.
<br /> • � '.: � ' Number of Stories—
<br /> • ' 31 ' / ': � J 1 Basement
<br /> .:. � r •
<br /> � ,
<br /> .` ;.� ��' . : . Signed By _
<br /> . _ . . ' . .' � I'or
<br /> . • � -, � . � Owncr Phone - . .; ,
<br /> . . . . . . . . . .�...
<br /> . .. • DO ;70T SC:t?T!: H�LOil TNTS ia:JE-POR CITY f1S_ g piti,�� .
<br /> � Datc `�ceiVel � ' . • . . �
<br /> � - - U�e� Zonc � .� .
<br /> ' PJan C:�ec;: :iur,.�,er . .
<br /> I'ire 7.onc .
<br /> Yalua:ion � •
<br /> ' � • . ' Occuoancy Grou� � � �
<br /> Pcsnit Fee . -
<br /> � -�_ Type of Construction „_
<br /> 1'lan Check Pee Occupant Load
<br /> • � RUtal Fee Due •
<br /> • • ---�_. £pzinklcrs Required '
<br /> Ilacc Yssucd . . . C..17', -,`-. .
<br /> . - � � '' � ii
<br /> � . .. ' ' A{�'F'Ii�QVS'1/ i�Oi���'J�ItUil^,G PERfvill �
<br /> , . , . . ., •
<br /> . . - � Datr.-•�;�' � F 'l ��_� (3y._��. ,`— ---. . .
<br /> • • �
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