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' ; � � � BOILDING PERMIT APPL2CATION � � ' � p���,! � <br /> -� : ' , , Applicant To Complete This :orm /��p /. ,'j <br /> , � • If more than one buildinq is to be cantructed, submit a separate permit applica-�/� <br /> . . tion for ea h buildinq. .l parate permit will be issued for each buil inq. � <br /> � � �er Buildinq Address � '/� . ' <br /> ' , , Bddress Lot � � 7i Block ���_ • <br /> . City Phone Subdi isi n (Plat) • <br /> � • ErChitect/Engineer � �0� yy �r— • <br /> '"'� Cily Phone lietes i Bounds (Unplatted) <br /> - - "j <br /> . ;, Contractor � Sec. 71+p. Rge ' <br /> � � . ' Eddress �� • • • <br /> ' City - l/, Phcn •7i3 � Buildinq Use _ •; .`�'.., <br /> � . ;� SWte.License Number�'y'3 ^D�-���'�Des�ibe Wo k to Be Done �.�' � <br /> • �i L=piration DatB � U��� <br /> :� ' � � SI�TCH PLOT PLAN BELOf4' • <br /> � . . f � Ose of Huilding � <br /> : { . ' , . . . . <br /> � � . . . . , . . . . ❑New Addition ❑ Repair/Remo•', e�l� <br /> � ; . ' � . : • •Valuation of Construction 5��"fI <br /> . ' . . <br /> -...., � .. ' . . ' • � PIAT PLAN REQUIRE?lENTS � <br /> ," . . <br /> � • <br /> ' ; • . Indicate lot size, name of streets, <br /> - �� � ' � • � ' � � �indicate location and wi3th of . <br /> . ! _� ., , • ' , alleys, lccate progosed aad all - <br /> � �'.� _ : existing buildiags, sho:+ distaaces <br /> . '- '! .'- to property lines, show distances <br /> , ? � � ' - between buildings. <br /> , . • <br /> � • � Lot size x <br /> •• ` • , Lot area Sq. Ft. <br /> r„ • • Size of 81 g. Sa. Ft. <br /> ` : , • Number of Stories <br /> . •: . j . Basement <br /> :.. . <br /> �. '_• � Signed By <br /> ; . <br /> • - For <br /> � . Owner Phone • <br /> . � DO :IOT S<Z?Ti B�LOt9 THIS LI:4:-c'OR CITY OS'n OIIL'! <br /> Date �eceived —" // 7�5 ' Uce zone <br /> ' Plan Check :Iur..Ser ' ' Fire 2one ' <br /> Valuation /�'L'� �� Occuoancy Grou� <br /> v <br /> Pemit Fee � �� �� Type of Construction _ <br /> Plan Check Fee Occupant Load <br /> . � 1bta1 Fee Due /�J. C U Sprinklers Required <br /> Datc Issued - // � __ • • � , . <br />