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. BUILDING PERNIT APPLICATION � Q ���j,� � <br /> Applicant To Complete This ^orm v / <br /> . If s,bre than onc building is to be contructed, submit a se arate � Z 7� <br /> p permit applica- <br /> � tion for each buildin�r. A sepa�. ste permit will be issued Por eaah building. <br /> Owner �y�K� Q i"�}/j�t�l�� Building Address �-�S �/�qr,�,C . <br /> c 1 <br /> Address jy-`„2� J �,ipp� ��,cc�,� Lot ��_ Block � - <br /> City ��,�Q�p� pry r.e . . .�'//3 c" Subdivision (Plat) . <br /> / s� ��� c���-�r-i� '�J <br /> Architect En ineer <br /> City � Phone � Metes s Hounds (Unpla_ted) <br /> Contractor Q, � , , /t[A�y��1!.(R+-��-/ Sec. ' <br /> n /+ '�p.__ Rge <br /> Address ,pp„%�{� 2 � � � -�. <br /> City ,%/Gt��� Phone �S� �/�� / � ��f �/J � <br /> Building Use ,S/�/��o L u - ..C�c;I�E'P�s��� <br /> �_.7r- � <br /> State License NumberZZj-C/-/.�,$'"/Q Describe Work to �e Done � <br /> Expiration Date G-�-7S � <br /> SRETCH PLOT PLAL] BELOW � <br /> �� ��'�� Use of 9uilding�,iy,1,� � t � <br /> � �/ <br /> . � eGCT � <br /> . . ' . , �New ❑ Addition ❑ Repair/Remodel <br /> . - ' Valuation o£ Construction 5 0��� � <br /> - ' • • PIAT PLAN REQUZRE6IENTS <br /> � � �—��—� • Indicate lo'c size, name of streets, <br /> ry�N �, ,y � indicate lccation and width oi <br /> � v. -z_ � � alleys, loc�te proposed and all <br /> � S� e6�+ � � �`��� N . existing buildings, ,show distances <br /> �_ r �� p� � to priaperty lines, show distances <br /> �Q � � 6' . between buildinys. <br /> U —�o�_' G7 'x /3'I.d4x 7l•.49 K /GS'.46 <br /> . ��� lo Lot size x <br /> a5� ' Lot area �(l�3Gi Sq. Ft. <br /> ' '��I� � Size o£ Sldg. �g5`L Sq. Ft. � <br /> _ . ,,�� �r Number of Sto ies B-y4,_ f <br /> �� Basement �.-u � � <br /> �� � � ^ �� �7 ,� /� ! <br /> /� �� Signed BY�!�Lvu�ff� �,y1LLtLi///� ' <br /> _ <br /> � r <br /> �/f�' v � ,�" /J <br /> . _. _ -''-t/' Z��.. — For ,�y!it7�-c��/J'//l�suGL��D I <br /> � �-�� �� - . . Owner Phone SSS-// S � <br /> - �-- ------- � � <br /> DO t70T WRITB BELO[d THZS LI:]F-FOR CITY USE O:vLY ' <br /> i <br /> Date .^.�ceived I - � � 0.e Zon� ���✓ ir� �W i <br /> P?an Chec'r, vunbcr _ Fire Zone �3 ' � <br /> Valuation — Occuoan.�y Group — ! <br /> Pemit Fee - � <br /> Type of Construction � <br /> Plan Check Fee _ _ Occupant Load i <br /> Tolal Fee Due _ Sprinklers Requlred <br /> . � <br /> Datc *_ssued r�,!��?[7T • � <br /> — C!i"i Q^ ._ � MI i' <br /> _ , U;i;r PcR <br /> ArPr-,o�t,-� , �_ ; _ - <br /> ��.. <br /> �� <br />