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<br />_' � .. f , - ,:� . � • • � � �OII,DZNC P£F2MIT APPLICATION . � -�--� l. .. -.���' -. i. #...`-
<br />^ • ; . . , • •• Applicant To Conplete Thi� gorm • '/ '�• / �'�':� ; : 'r '
<br />.: Zf more Lhar. one buildi�q is to be contructed, submit a separatc / /��� . �
<br />, tion for each 6uildin �� 7�
<br />q• A separate Pe�it applica- •
<br />7 permit will bc issucd for ^ach buil3ing.
<br />• , � Ovncr �( . �� 1��� i (l C� i� � � .
<br />� � • ��� y� �� 1 ' IIuillinq Address ?�� � ;� .` `�., `
<br />.'. Mdress 1�t' _? �'t n t r�' LOt .�._ �-_ ,) ,� Block '�
<br />. �tY ZiU��"C} Phori � c`" ),• � Su�di4ision (Plat) l � SZ I �
<br />< ----_ � L.-
<br />_ . � ' Architeet/Enqineer ��C .� � ,�' l � ��`-�
<br />a .l � `)C' (t
<br />. :,'' . ,
<br />- • _ •-� City `�(' � .' C l �l 1 E Phone . Cj ,�I, �j t(etes S Dounds (Unplatted) .
<br />� . :�'. Contractor �1(.Y��-! �-i� ,....�1.. • - -
<br />J—C1.i_C._F..t4.�') sec. �,,�,. gQ�
<br />- ' �.'dress o �(� '- � � ��_=_ • .
<br />..1 «ty L � � Phone � � ��� Buil3ing Use � .;, � �t.
<br />_ .{� .. �-��� ii., << t-l�as'�� � e -
<br />'. '"� ` State License Nc�ber z_ �<<ir' ,:. � I a r
<br />. Y� `��•� �'��� � ��� � ]k_scribe Work tc He.Dane���_
<br />� ; - �:' ..
<br />; � �I Hcpiration Dat� � � G � r�� ' . .
<br />° Ia��cJscnp, �— � ---�-- ..
<br />� ,�: ' - �(�cc_tr:_l'-f��1 <<�,��I, ,.c1t'�
<br />� . .: . ' SRETCH PLOi PI.1: ?gLOiC' . .
<br />. `- ci . ' ' - .. • . , _ .
<br />. IIse of Buildirig .
<br />_►' : . - • • • '
<br />' ' ,.. � " ' ••• . ��eW ❑ Addition Q Re air
<br />i' P /Remo�el
<br />� ' ' • Valuation of Construct.ion $
<br />�..,.. • , � . _ _ " - .. . ' _' I • . � �
<br />� � �• . � � '' "" . - - PIAT PI.A2S R£QUI_TLL.ITS I I�3'� O . .
<br />' f . . . . ; . • ' •' . ' . r� z.
<br />. _. i . . _, ' . : ci .
<br />- • . "' - " ' ' � Indicate lot size, nane of streets,
<br />' • ! ' , " � �=: �� _ � � ' ' 'indirat-e locatior. �er.c wid:'� of
<br />• ' "� . . - . .. . . - •-i, . ' allcys, locatc procose3 end yll `
<br />3 � , . ._ y ' ' , ��� ' existing hnildi.. s,
<br />� '4 sho:a d:s;ances
<br />, ; • T.a ^ ' - . : ' • to property lines, shoW distances
<br />. �, _ _ • _ , . between buildings. .
<br />. o' . . , . • - . ' - ,
<br />Lot siie x
<br />- Lot area
<br />. Size of IIlcg. ""----- S4' Ft.
<br />Number of 5 ��--- Sa. Ft.
<br />tories
<br />Basement —�-----__
<br />Signed By (' � 1 I � '
<br />. i.
<br />X For
<br />�n� Phone ��,� ��,�
<br />• . . DO .\'OT Si;2ITB 3ELOh� 7� r I•�i-POR CITY USc OiIL'I �
<br />_ _ Date .^.eceived lFj (��' � •
<br />�"-1 Uco- Zone
<br />Plan C:iec;; :Iur.Ser • �
<br />----_
<br />Valuation % �,, '� 7 �U
<br />' -�_._�__
<br />Pemit Fee '(p�. �-
<br />Plan Check Fce —
<br />• ; 7bta1 Fcc Duc � i�- ��
<br />Datc Issucd � �I -� I-j �' '
<br />. . � . -_ t �--��.
<br />P
<br />Firc Zonc
<br />Occuoancy Cro�
<br />Type of Construction
<br />Occupant Load �
<br />Sprinkler� Required
<br />� . . .
<br />
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