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<br /> _ �. •:. � . • ' ' ' DUILDING PERHIT APPLICATION /.- nG ,Zt��.�t ,�• •v
<br /> / % B 3�' �1
<br /> : App].icant To Complete This :orm / . /O a 91?�.�;
<br /> . . � . .. . . . � .
<br /> • ' u vwre than one buildin q i e t o b e c o n t r u e t e d. s u b m i t e e a r a t e
<br /> � . . tion for each buildin '' P p c r m i t app l ica-
<br /> , g. �1 separatc permit will bc issucd for each buildinq.
<br /> . � ' Oraer __ l�� l�i iatvYi l� Ti�1 c��,�- 8nildinq Address ' �� or � ,y<<.,,, �'{".' .
<br /> . •.` • ; � 3ddress _J D � �c� •_]"� S .E Lot !U-I v�1 � /J nlocx _67f ,
<br /> - , . City �JfR_cf'+' Pho�e - 07 Subd;4ision (Plat) , nF rv��rC� :
<br /> � �x�C6ileet/Enyineer , � ► � ' •
<br /> . ' V o� S ��� ,�.. _i '1 C.•i. !` . . .
<br /> . ', ' `.'� �i J^i/ • Phonc
<br /> = • ti .'' •-j � Metes i Bounds (Unplatted) ' .
<br /> :.� . , � . . .
<br /> :�'. Contiactor ,S' C�� ' Sec. RWp. Rq� . , '
<br /> ..� . __
<br /> =• ' �. . �• �LCSS ' � . ' . . . ' - . .
<br /> . .t City !� J Phone . Hniiding Use . ,-., � :.i tP r,.)�• � �
<br /> —�-- `� ' „p '�:
<br /> � �'�� � State,License Ncr�her Describe WorY, to Be.Done ►'.�
<br /> . . . . . �'q� , .
<br /> : .• 'i Lipiration DatE • � • � � � •
<br /> L�' . ' SRE1'Cfi PLOT PI.A.N BELOfO' • • -
<br /> • j •�� • ' . . . . . , .. � � ,p '. . • � �
<br /> . .
<br /> Ose of IIuildiriq r` �".Yf
<br /> �, • � _ . . . . • . . � ' �New ❑ Addition �
<br /> : Q Repair/Remo::el
<br /> � �' � � . • = • `Valuatio:t of Constructi.on $_ p'Qf�• '?t� .
<br /> � '• . . .. _ I .
<br /> �, . � � .. . �' �.:'• . .•'.. �. �� .. �' , , PIAT PLAN REQUI?2&1fENTS , .
<br /> � ' • . � . . � . . � . � ' :,�
<br /> .- I ' ' � ' . . ' � ' ' ' I,�dicate lot size, na�e ef strcet�, �
<br /> ' ' '. • •indicate location an�' widt:i o:
<br /> ' ' � � ' . ':' ' •• • ' allcys, locate nropo�ed ard all � '
<br /> • .� i�� • • ;:�t.:_ � � � . �'��� ' • exast•ing buildings, sho�a cistances �
<br /> . _ . _. . to property li.nes, show distances
<br /> e. � '• �, , . '_ ' , . between buildings. .
<br /> ' '' ;' '. : �. . ... , • . .. ' ' . IAt size x ' •
<br /> . •` � ' • • � ' - , . Lot azca � Sq. Ft.
<br /> • r.. . . ,: • ' Size of Bl q. So. Ft.
<br /> �� - ' ' Humber of Stories
<br /> .r: ' :: . j. • . . . . . . : Basement .
<br /> � . . Signed By �� 1J .' %,G .t.� '
<br /> . 's. . ' . — -
<br /> . ; . . . ,
<br /> . '- ' ' For
<br /> •� � - . .. - . ' Owner Phone � -
<br /> � .• � DO NP: Si:22T£ 9?�OE7 TIfIi LI:1F.-FOR CITY USz O:IL'1 '
<br /> . Date �eceived l0 -,:� �� ' p�e• 2one � � '
<br /> • Plan Check :7ur..Ser ��s ' ' • • •
<br /> � �/ Fire Zone
<br /> Yalua:ion 4=�i��70, Or '� Occunency Grou� �
<br /> Pemit Fce �Z-� � Type oL Canstruction
<br /> Plan Check Fcc . ��0• � Occupant Load •
<br /> . ,,: Ybtal Fee Due J�Q ' d b _ Sprinkirr� Required ' � ,
<br /> Datc Issucd • ' ' ' ' •
<br /> • • . . —� . .. . . . ... . . • .
<br /> . .. . . • • .. . . '' ' .
<br /> . ' . . . . • - � . . , . ' . . ' , .
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