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, � <br /> • 'i • — • • • avzr.nn,c rertrtiT nrrLicnTzo�a • '. ' ' .' j: � . `�:,j � <br /> . ���: <br /> _' � •• , • : $opll.canL- To Co:n�lctc Thia =orm . . - '+ � <br /> .. . ;. . . . �' ��a9./�,s'"'. <br /> • • ' If norc than onc Uui7.dinq is to bc contructed, suhmit n ^.eparatc pci-mit aPplica- <br /> � . , L•ion for c�ch building. A separatr permit will be i::;ued Eor each bui].diug. . <br /> • ' ' O�mer C 1 `rY �o�= ��r�=Tt- Dttildinq Acldress � 2/.�/ H�V/'rT' : <br /> • . � <br /> � ` <br /> � '. . 2�ddress C i� Y I`�.�-� Lot �7iG�, � .��' Dlock �O�G�i <br /> . ' . City �V� Phone Sulxiivisioa (Plat) • <br /> ' - Erchitec:/�ngznccr � ���-`�Zl-"�7�7� ' ' <br /> _ • '+ °.i City Phone bSetes & Lounds (UnplaLted) ` : <br /> , � . ;,', Cantractor � i7-f C�t'- �"',-��-ir:L�-T Sec. 'hrp. IIqe . <br /> _ � . <br /> '. %. . ' .�Bdzess � . , <br /> _ _ . . � <br /> , •' -.City Phone "Bni.ldiag Usc ' ' `'�:�5�. <br /> �"' � SCate License 2Ic.:.ber Describe Work to De Done � � �" V <br /> �i - <br /> • �•• .I Expiration Dat� `-,��.li�� G✓6 !/ 57�'UGYC/,L�c`�� <br /> ti . . . _ <br /> . �� ' ' � , -� S1'S.TCii T'L'OS ifdvl nELO'.4' • , � <br /> .7 • — • . . <br /> ' , •. j • " , ' lJse of.11uildir.g . � <br /> i. � �� ' . , - ' _" � _ � ; � L]he;u ❑ Adoition ❑ Rcpair/Runo::el " <br /> ' ' ' � • ' ' .� : 'L�aluation of Constsuction $ Q�• �� <br /> !� ' ' . . <br /> ,�. � .. • . � . - . 'PTAT PI1sId R.QUIRE":;7TS . . <br /> �. . . • . . I � . . <br /> R • <br /> • ; . . • • . • . • ' Indicat•e lot size, nane of. strec:s, <br /> • � ' i • ' � • • ' + ' � •indicatc loc�tion �ar.d o:i.dth o� <br /> . � , " i'. � . ' . . • alJ.cys, •locatc aro?osed ..r.d a�l . <br /> �.;•;f ' , ' , . . :.. . .er.i�ting buildi:ga, shc:a,fl:::lances <br /> j * • ...-. - .- �a : • .': . . t•o yroper:p lines, show distances <br /> ' '1 , . .A • . - _ bettaecn. l�aildings. _ <br /> � ' . . • <br /> - . • . I.at �ize X <br /> 1 S � • . <br /> . . � . . Lot area uq. Pt. <br /> � � �. �, �: � � �Siac of I31dq. Sq. Ft.� <br /> � . <br /> . ' � � . . � � � 1tllL�1�C- o� tiL'C1'lr_5 <br /> . '.: .�y ' . . IIase:nent <br /> .•.. , •— <br /> '1 � " '. . Signcd Lf �Q�r�r�^—� <br /> 1. . � . . For ��� C-1CG.G�G� ' .— <br /> � � ' • Ucan r Plionc <br /> � ' PO :r0: 5�:2?3_Ti �-LO!7 :'1li� LI;]iY-FOR Ci7'Y US:: Oili.'L ' _�-- <br /> : _ Datc S:ccived ___7��� "-`--'�.� U:.e� 7.one - ----. . <br /> ' Plan cticc: �:w:.5�� ' ; r•irc Zoie ' �� <br /> Va:uation � vC✓ � � � Occtronnc� Group ---- . . <br /> � Ycznit[ Fcc ___� `�_, lyPc �L Construction � <br /> � Dlcn Ciicc): Pcc — . _____ Occup;:nC I'�oad �r_._-� <br /> � , � abtal 1'cc. Due �O� � CJ � Sprinl:lcrn R��quircd � . � __- . <br /> D:tc Isoucd . / /�Q�__ • • : � � - <br /> ,`y . <br /> � . . • ' .. • . . � �� 1 � M <br />