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<br /> ' . ; � " ' � ' DUILD7HC PEIUIIT TPPLICATIO[� , � � � qr�� .;,�'
<br /> ^ % ' : Applicant To Complcl-c Thi� _orm • � //'.��
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<br /> ,. • • If raorc than one buildinq is to bc contructed, submit a sepazatc pci-mit apnlica
<br /> : . . ¢ion for c�ch building. .l separate permit will bc issued £or each buil.ding.
<br /> . � � bmer 5��,,,� s !3. ii�o /4-r�� Duilding Addrecs 3�s' !/ea ��+« /r�p, :
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<br /> , ' . . L7dres3 �af' /-/.k /S'i..� J� s_ Lot / � Block � '
<br /> ' � City �.� ?- . Phone 2 S-,� - /�,"� �ubdivzsion (Plat) � .
<br /> ' - drehitect/inginccr � �fu fi /a d�!�¢, � s '3 • •
<br /> _ •_ ":f City Phone .I�I�tes G Lounds (Unplatted) •
<br /> . � . ��,'. Cantractor �" �c'•rrr � Nec. 1;r1�. Rge . .
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<br /> �' • ' lsddress � � •
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<br /> ' ;City ,Phane `Building Ose �.Q rr �.,,. �f�a / ' ' `'-.;�:;r�,.,
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<br /> � � ' � Stzte License t7�ber �Describe F7ork to IIe .Done��_ /�'re � r��'~��V
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<br /> • .. �I Expization Dat� � � �'� // •f •
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<br /> • �� ' ~ . , -� SP.CTCFi FL'OT PLi,Di 9ELOf�7' • ��C! F� � .
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<br /> . ::1 • . . • . , ' - . . , ' �9se of. Buildir.g
<br /> _a• � .�� , . : :ew ❑ hdditzon �Repair/Runo�el
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<br /> `���� _ ' � ' • • - . . • -t'alua' �on o£ Construction $15 Q• " ' ��
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<br /> .. • . . • � �^ . iST,OS PL7�27 R•^;QUI�':::TS . -
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<br /> � ' ' ' : ' • ' • ' ' Indicate lat size, nar..e of streets,
<br /> �• � ". � • �iniiicatc locat-:on ar.d wicth of
<br /> : " ' •
<br /> • � , _ �� �• •� � � _ � • • �-a17.cps, 'locate �ro�osc3 a:.d a'_1 � .
<br /> � � ' _ ..'. - � .. ' = . . . �•er.isting buildi:gs sho:a dis�e.aces '
<br /> _ ' `q . -.L'U 7?Yoi7CYty lines, •siiow distances
<br /> , � ' ' •4 • - betwecn. buildings.
<br /> � ' . . : - . �t size o�.X/3 7.x� K 7�,i�7 X /GS�N(.
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<br /> : , ..- ` . • . Lot area !0 3 � G Sq. Ft.
<br /> • ,;, - _ . � • � . . 'Sizc of I31dg. Sa. Ft. .
<br /> � ` � , • Iiuube: of Stolir_s
<br /> • �. • i. � . • '. � . IIasement �
<br /> .:. . � . � . ..
<br /> � ', -'- ' ' . Signcd Ly �..c,l� C:l/c.Pt'y-��
<br /> • � . . � For z.C/_ ,���—�,,,.,:r '
<br /> . • Uwncr Phoiic,�—
<br /> ' : . • . � AO NOl {i:i?TS 9EL0:4 TISIS LI:li:-�OR CI7'Y i]Sc: Oi7li'f �
<br /> . , Date �eceived ' � U�e� Zon� �� / ��,•� r�
<br /> ' Plan C�ec;: :7ur..bcr ' ' Fire Zoie �_3 '
<br /> Valuation ' O�ct�u�ncy Group _ __
<br /> � Pcmit r•�e ' � � � Tyr;c of Con:tLvcCion -
<br /> Plan C1�ec1: Pce � Occup:�.nL• T�oad _
<br /> , 'a1;tal I'cce ➢ue _ �.Spzirl:lcr� R�_ uired � ' � � :
<br /> � • � ci�y or.- FvE)�`f'F�' —'
<br /> n:sc xc:sucd _�___. � APPROU�D•FOR�BUILDIfdG PERMIT •
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<br /> . .. . Date�l�.L�-By,_�-�__._. ,� .
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