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'^ � •. � � • ���u����v • ��u ��LLl.ttllVt\
<br /> - • . , ' � Applicant To Complete This .'orm � '' ''`;J
<br /> ; • •
<br /> � ' � T! more than one buildinq is to be contructed, submit a separate permit .applica- •
<br /> , • % tion for each buildin3. .1 separat� permit will bc i�sucd Eor eaeh building.
<br /> • ; � Ovacr �,. .y. ��l%',� � ,/ L . •
<br /> � � , " L" V�.� � Buildinq Addzess -�2� ,3L � �
<br /> ' dddress / (, � - � , '
<br /> � • : . z, �'l� tot_ / � 93ocx _( � y��_
<br /> � • , �� - '�-� P � ne ;,t,5-�,� � g�3i4ision (Plat) '
<br /> � . � � .
<br /> _ Lrehitect/Engineer '
<br /> . : � . • S�;<<: , -�- �,1,�� � �3 � .
<br /> ', ' `.'• City Phone
<br /> :.+ '� � tietes 6 Boun�s (Unplatted) •
<br /> - .:,'; Cantractor . � �
<br /> ` ...� , Sec. 1trp. gQe , -
<br /> _ ;, . r� Eddress ' • .
<br /> ` t City Phone •
<br /> •i; . �_ Hnilding Use � � ' �
<br /> . . =:��
<br /> ' �r� Stnte.License Nuaber _ �scribe Work to Done "t•''
<br /> : �.�1 Ezpiration DatB a ' . . + . - � � i ' .
<br /> + .� -t i.l, � •.
<br /> `` � 1 ' SRETCFi PLOT PL.l'7 BELOW' a • �� ' . .
<br /> _ ;j • :
<br /> ' e� . . - , , a�� ' '�T—
<br /> Ose of Buildirig ;, -i-�
<br /> � `� �� � �='a_
<br /> a• ; ''��� _
<br /> • ,a- . . ��d-�vip;kLn«r ..�� ... ' nt7ew ❑ Addition L7Repair/Re.� .
<br /> . �. . . .. ^,e - . �F.t7
<br /> •• . , . � , .: : . .. . � . i.
<br /> Valuation of Con�truction $ �
<br /> -,.... . _ . . �. . . . � .
<br /> � �. . =��" •:._'' - ' , PIAT PLAN i2EQUZ3��L:7T5 � :? .
<br /> �• � �����' / �� ��� �' • � Iiidicate lot size, nane of streets, . �
<br /> ,� .' � � � �: :44'�'u'�-.% . � �. _ . . � • ' •indicate locztion anc w:cth of
<br /> . • :•'� ' - ' • • ' alleys, lwate proposed ar.d all � '
<br /> :. ,� : • '�� . ' � existing bnilciaqs, sho:�� distances
<br /> � � � - �Tt ^ • • �_: .� • to property lines, show distances
<br /> �' : �' �. � , between buildings. .
<br /> . '� • �. � � . , ' ' . . - ` ' .: Lot size ' ,
<br /> ' .'t 7 J -�,��` . �� ' �.�_X
<br /> � �: �""��"""' Ld � . Lot area
<br /> • �_. � Sq. Ft.
<br /> . . •.j � � . • .. ,. :�� . . Size of Blcg. � Sa. Ft.
<br /> . • :; ;� • Number of Stor�es y,
<br /> �:. _ • ' � . , Basement
<br /> • +. ' ;/ � . : _ . Signed Bg� �. � ���//c�-c[,>�(�,) .
<br /> _ ^ I . . , �
<br /> jI • /�'�b�/� .� 3 j.'�' ,.. For /
<br /> `, � %uC� ✓
<br /> ��� �n� Phone r
<br /> ��/ . 'ly-'tv�,..c` �cu'�' ,LLt � . . . '. . V
<br /> . '- • ..... . �DO :10:' Si:2T_TL' D�LOh! THIS LI7E-POR CITY IIS OiIL'1 � � .
<br /> : ^ _ DaCe Seceived � � O � Uce 2one � �
<br /> ' ' Plan CSeck _7ur.5er ' ' Fire 2one �� - .
<br /> ,Yaloation ��`�,{`�; F�' Occuoancy Cro�
<br /> Pesnit Fee ' �j, �'�—" . •
<br /> • . Typc of Construction
<br /> Plan Check Fce �— '
<br /> Occupant Load
<br /> - ; Sbtal Fee Duc "�� `�-�� Sprinklcrs Required • '
<br /> Datc Issucd - • • , ' � � •
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<br /> , . .. 't.. . • . .
<br /> . . . , • . . .. '•� ''• ' .
<br /> � . • ' . � . , � • ' • � � .
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