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. . _ . . _, _ <br />— . . � . � • ' .� 9��.��� _�' <br />� IIDILDING PPRMIT TFPLICATION � � ' • ' • �•�T <br />' , • , � Appl.teant To Complet,: This .orm ` `'. �: �,� <br />. . �f '%S <br />/� <br />If nozc than onc buildi.ng is to bc contructed, submit a separate permit applica- <br />tion for eacf� buildin3. i� separate permit will �� issucd Fot each build;,ig. <br />6mer � I�Ac r" � � i iic� v ' f% ��-- -- � <br />,�1F� Duildinq nddress 5 D �. v; <br />Ilddress yS � fiC�S?' � :ot i5'9=ySv5i Bloox a� 9 ' <br />City � �/1P� phonc Sub3ivision (Flatj �jr/��� fi���� ; � <br />LrcSitect/Engineer � •I <br />filr <br />_ .`_j City _ Phone Hetr� � Dounds (Unplatted) <br />' . .�'. �CCJIItTdCtOL �C�C[YF /�'%/��wim.�G( <br />• , • - ._ <br />, .� .�d3ress _ L/�/� �C1��E�/f'� -- <br />! -City �1Le�PE�J` Phone �� � ✓'�.i0� <br />_ .` I , . . . . - <br />;� Stzte License NL:..ber �.�3 U� /33�3rj <br />: �.�1 7�ixation Dat� C/� �� 7�. : <br />'�' �~ • S?:ETCIi PLOT PLi�] BELOW' • <br />• j ,' I . . <br />�/�'e � <br />L:-� :.i .-��-�� . ;__-7:. <br />. � _ " •1 . . 'I ._ .. <br />< � • , �� . _ . <br />�- '. . .-f. ; _ . <br />; . -. . : <br />�. � ' �' . '-Tl` '�_. .I ' . : .. <br />�?� • ..-. _ '- . . . <br />. ., . �.1 � �:� ��.. - <br />. a � �� ` - <br />' ' ; . _ _ � : _ <br />. ' -' . <br />'; <br />� ` _'.: <br />. Ir ` I <br />' I � <br />: ` ���,T" <br />n �om s•:z*T� s=*o�� <br />D1te SecClved � <br />' Flan Chec;; :;u.:.Scr <br />l'aluation ' <br />Fezai.L Fce � <br />1'�lan Checic I'cc � �_ <br />. ;:uta). :�'ec Due <br />. P:.;c I:::ucd . --� z� %�'--- <br />Sec. �,.P. �g� .. <br />-"ESuildiilg IIsc � � . ' � � <br />��-� �,. _ ., <br />Describe t4or1; to Be .Dor.e /, � � � <br />p �,�1 ��':.. <br />� �,f�4f ,Jle/�)t. �"� Gc> e /�2� G(JZGIf� • <br />IIse o: Suilding <br />�1deN ❑ nddi.t�on Repair/Se¢ic`el <br />:` <br />a,iu�t��:, o� c�z�t_u��_on s �'DOao. . <br />,rr,oT rr.�-ua s:�.u�::���>:Ts . <br />' �]Cndicatc luL si.ae, na_:.e of treets, � <br />•in3icate loc, t:on ar.3 wir'thJof <br />' allcys, �locat� nroposed a :d a17, � <br />' .existin9 bui].d:ags, shos� �istaaces <br />� ��io propert}• l±nes, chow dista:+ces <br />_,bettrecn builriings. <br />.Lot size X <br />Zot• area - � Sq,. Ft. <br />Sizc oi f31ag. Sa. Ft. <br />� .Nmnbcr of Stnrics <br />Daser.!cnt <br />Si ned II� � <br />4 s' �..et 7.�.� ,G/>7.J�i� <br />For �/1.S ,L JC �ctc <br />. . . .Owt�cr Phonc _ � -. <br />LI;dE-iCR C'T'L 'JS: O!iL'! � <br />U�o- 7.one <br />Firc Zonc <br />Occuu�ncy Grou� � • <br />TYP� �•E Construction � - � . <br />OccuPinl: I.oic1 <br />�r ,�.. ����� F�/Efi[TI -- <br />r.inlcl< I:�� , �ir.�r pt'RMIT. <br />. ;sl'f'ROV�D F�i+t-�*��----- <br />�i7n^�� �L'�Z�'��.'t3u�.�'�C��- �._. <br />i <br />r <br />