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. . . . . .M1 ` - . . . . . . ..� <br /> , � � . .. , . . BOILDING PERMIT APPLICATZON - � . ... '-f^ `-.�-' ,�• <br /> ._ t /' j ;l/ ` ...vt <br /> - ' ' . _ I►pplican� To Complete This ?orm � , , <br /> .. . , . . ��/j' f %;• <br /> , • • � i! more :han one building is to be contructed, submit a separate permit applica- <br /> . . tion for each 6uildin3. A separate permit will be issued Eor each buildinq. <br /> . " � dmer -�e�;E�t-� �. �'({�C�.lcll,l,l Buildinq Address ��i �`( .� k�L�CS�»l� : . <br /> . ' . Eddress I�iC�i Jc�C��S3:t,� Lot Block . <br /> City f�VC��(C:L� Phone �iS� '�'•�c ; Subdi4ision (Plat) • " , <br /> ' • lrehitect/Engineer ��=�'-F � • , <br /> •� `'� City Phone Hetes a Bounds (Unplatted) <br /> - _ ._I <br /> � . :,'. Contractor =:�� L I- ' See. 1Wp,_ Rqe , - <br /> . � . __ <br /> z. � EBdress 5E�1L1[ . . . . <br /> '�: City Phone Building Use �)((lti'k,5��7(_� . =�.; _£ � :_ <br /> �'l� ..'.I:. . . f . .-.- <br /> �� � �;j � SWte License Ncnber Describe Work to Be �Done 1-�-�I U�UO�� �` <br /> � • 'I Scpiration Date s ' <br /> _ ' (��0�)1'� !-('l�-G�1� C�� `I��i�E <br /> ,,1 <br /> �� ' ' ' , � SRETCH PLOT PLA!7 BELOSQ' • ��lJ I l.l�1 NC^" - <br /> - • � ' . <br /> : �: { ': , _ � IIse of Building ln�0(�K.�1�U�� • <br /> �' I ; � r � , _ , , � �New ❑ Addition Q f.epair/Remo.:el <br /> • . �,.; ' � L•��l ��V��.' • ` E�: <br /> Valuation of Construction $ s��- <br /> . . i-_—���; , i _ <br /> -�-• . '' ;�-� . . .. � � . ' ' . . . PIAT PLAN REQUZ�2&•IE:ITS . , � . <br /> . -... <br /> : � �, . � � � . _ <br /> � i ! • ' Itldicate lot size, name of streets, � <br /> - ���.�} � I'� �� • s.� ��j� � ' " �indicate location and width o: , : � <br /> ' ^J � `:. � QJ ' �• ' � �� _ ' ' alleys, locate nr000sed a.^.d all � <br /> L �� . . v�� �� � . � existing buildir.gs, sho:a distances <br /> . :.� � . i � � ;.. � • - '- `!•v i3O;/� . . '- � . . to property lines, show distanees � <br /> i � � I .. � _ between buildings. <br /> �J) � V �F151.1 - . ' Lot size 'I �' x I�O • � <br /> � : �--. No�SE�' <br /> ... � . . Lot area �y �>O sq. Ft. .. <br /> '�jr = . � . Size of Bldq. �C+Z sa. Ft. � � <br /> . . Number of Stories `iN(7ic <br /> • ' `+-�-1--- • ' Basement �JoN F <br /> ':• - Ti20N I , � �C - <br /> �� '0• Sl.gned By �1�1f,�,1 7 1{l(U-���,1 \ <br /> � �,. IQ�`'� � JF'1Ck'S� all . c t� ,,n _ _ <br /> For _tl��'v�.l.� �• rt��*-I�CLti� <br /> .� . . � Owner Phone _,��-,���� <br /> � .. ' DO ;IOT StiZT_T£ B2LOF7 THZS LIN£-POR CITY USE 02IL'! - <br /> Date �eceived Dte Zone <br /> ' Plan C:�eck :Jur..ber ' ' Fire 2one - <br /> Yaluation � �C.� • �-'� U Occuoancy Grou� <br /> Pemit Fee f-j � �� Type of Construction <br /> 91an Check Fee pccup�nt Load <br /> . � 1bta1 Fee Due Sprinklcrs Required ' <br /> . ' Datc Issued • . • • � � <br />