|
. � �.
<br />� Y
<br />- � j . . • II[IILDIR!: re�urzT nrrr,xcnTio;� . .' . . �. I� �� �' :.,•I
<br />.. .' � . . I+pplic�nt To Co:npl.cCc Thi� Sorm . '7/3��j :;
<br />i•
<br />••� If �wrc th�n onc 6vildinq is to bc cont•ract•c:i, submit n ecpatatc permi� applicn-
<br />., tSon for cach huildin7. A separace permit will Le is;ued for eac1� Lu�7.d_.ny.
<br />/ , / / _� „ �
<br />. �6dneY 7'/�7/iti - �iS���'�'P� �.`e�CG,%jSuilding Addrecs � �'�,� 7'��'�
<br />.i ' -�' � - /72',
<br />. rildres.^, , , , �. � LoL-> �, "I,,?,���' 31od�/- Sl` � �?-�L' •
<br />Y �- -��--- d '- --
<br />�, . . � �. . � �, �-�_�.�I'7 t%5"`i � f7-6'L"
<br />. Cit / ;" Phonc,�,?.-'//� f Subdivi�ion (Plal) _ �
<br />, � /
<br />• F.xctiitcct/�sKF'�cr f'� i� !-�. .� � GtP �� ���� > /� �. � �. � , . � �L :
<br />.. - � r p� � , L / ; , . , r L -
<br />' :..� � '7 �'�' %'%.� �i -� /
<br />' '• City ��'�/ ���L� Phone 'z � ` 7.l�S�tes G P.ounds (Unplatted) �
<br />- - "j ---
<br />. �,'. Cm�tractor '
<br />. ., .
<br />S,dress
<br />' -CitY Phonc
<br />,'_ ; .
<br />-� .�'�� � St:.:te Licence tlty..ber _
<br />: � �1 1:'rni.ration Datr �
<br />�1 : � � .. S}:1:1'CI3 ?'LOT PLA:7 3EL0[7' •
<br />_ "1 . ' •
<br />. _..1 . . " .. ' . - .. .
<br />t• .. . � , ' • . . .
<br />. .'}, . . . : .
<br />� . , . . � ��1� L'�t /
<br />� . ; . . . "����z
<br />: �i . �..�\ '�.' . • , r
<br />f \ r � �'/��.'y`'
<br />.• �•�l , V . \•• Y�r �.� .�f� i
<br />�V �
<br />^eC. � Tc.27. � P,gc �
<br />�
<br />/ �
<br />�/'el 'c �" ' '• �
<br />}luilding D�e i c E� �«>'� i�;-`a.�� ��
<br />Describe S7ork to Be �Done- ��7'7c^ � � �-����
<br />� �- i
<br />� �i�i i�t. ' .�['� Y!� s -q�trl��5 C> � �� L--,_. . ..
<br />-�—
<br />Y� ��i7Yi << � �f// /-7Ta; � Ll�: / � '
<br />�i• ��,�,� ���:L'' .'`��-c-�-+ .:-L4.'/!(LC��r✓J= .
<br />Dse oE Duildir.g � � _
<br />❑l:r� �I.duition ❑ Rcpair/Runo::cl
<br />:` c C
<br />6'aivation oi Con�trucCion $ / `C �� �'���',{ �
<br />rwT ri.r�� p�cozsL�::xs
<br />'t' � Indi.cate lot size, nar..e of ^trcetr.,
<br />�dicn`x lor_ation �ar.c o:i.cth o:
<br />'�� all.c;�s, 'locatc propo�ed a;.d a.'_1
<br />�j � . . � .cr:i�ti.ng building_, s:�o:a �'ir.;:..ac,�❑ '
<br />� *� - -�1 ' '�.a d. i �
<br />�'� ..f �� q • '�
<br />;
<br />: "'� . � . � I; ,�'.
<br />� ' ��i �� L��.
<br />/,�,+cf�t: � .
<br />��,�� �
<br />��� r �����,,,.
<br />-`= . �_1_--� .
<br />-.L'o pro�cr'�y lines, st,ow �zstancc_�
<br />IG'✓�..�/.. ' ,• h- betwccn Luil6ings.
<br />� . �{Ct� � � i
<br />���`; ���� �7 i�ot �ize / /2� x � ���' --
<br />����i y . T�t area _=i-� � c-� sq. rt.
<br />�size ur r,iag. � c:� -n so. Pc.
<br />� • Iim��ber oE Seorics
<br />_ �-.-_
<br />. :� � y�� Li
<br />7'or
<br />cr
<br />,
<br />;_, ;
<br />�
<br />.• � DO :O: kZ7P5 �2L0!7 TH2;; LI;Ii:-��l�P. CIiY tl�;i Otii.'I � � -
<br />. Datc �eecivice7 � U:.e� 7.oiic
<br />� ' P]an C:�ec;; :7ur.,bcr '
<br />l'alua:ic�n '
<br />Dcniit: I'cc � •
<br />I`lati Cl:ecl: 7'ce ' .
<br />. rVtal Pcc llue �
<br />A:.t•� 7:.aucd � • � .
<br />t•irc Zo,c
<br />Occ;incincy Crou�
<br />R�rr�c of Con:iructioii
<br />Occur,anC I.u�d
<br />Spri.�:l:lcra P.oquircrl
<br />. . ,
<br />
|