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<br /> •. •.� : ;s . — .. � . • aazr.�nac rrnr�zx nrrr.icnr.or� '. ' ' .' ' ,:'' . �x� .
<br /> � • � , , � Applicant To Complelc This :orm , ' • •, �� ,. . ; ;�
<br /> . .
<br /> • ' Ittsore than onc buiJ.di.nq is to Ue contructed, snbmit a separate permit applica-
<br /> , . . ¢1on for e�ch building. A separate pecmit will be is�ued for each bui7.diug, j
<br /> � :[1�:�y .
<br /> . � ' 6+ner Duilding Addre�s �� L/trp _ ��•j�, (
<br /> ' . 7�Ldresa ,�•4/R .�vi'u � l.i. L Lot IIlock
<br /> . —�t ' -�_. .L..�_ G9d-� 9/-GYZ-�`�
<br /> ' �• � City �a ' T�r /i;KSPhonc 75S=o1[�/ Subdivision (Plat) � j�.js/�A j �
<br /> � .
<br /> • 1�schitect/Euyi�icez �=1.iG�z S u.w_ •
<br /> •:� "'� City ���-�arn_� Phone �;2?�-7 r'C_o t•fetes L Lounde: (Unplatted) '
<br /> _ . =y _ •
<br /> � . :,'. Ctmtr.actor �u`i!-L} � �h'�� Sec. Tcr��. Rge � ..
<br /> � . _
<br /> _' ;• •.'- �ress '�..�J .: �`�._� ?/'::� . � . , ' ' � - I
<br /> �
<br /> . ', -.CitY /_! ���.V :Phone `l3nildinq U.,c �L: /J.-,i )�t,!u�:%"�':� �... I
<br /> �� �~� � Stzte Liconse 27i:s.ber a�� ' �-C' ! - r:rttj' Describe TPork to II�� �Done� �� � ��''��
<br /> �i'� , �%:en..� L I
<br /> • � �1 Eni ization Dat� tl'- / - 7 (r� • ;-o P � _ r:�. i
<br /> . . _ f C�r L.. l ,".c•_ _„ . 5L
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<br /> . � ' �� . • . . . � I
<br /> . sr.�i��it ULo^. riw?r ?�rLocr' ,_- -.� � , �'., � � -,---.
<br /> ..i . ' � . . .. � „ , _
<br /> • • ! '� ' ilse of.Buildir.g - ,:,r: r -
<br /> ' ' . :A Sr'• . T•I' : .rirtC_. . . ..;., , . ; --- . i
<br /> ;�:
<br /> •' . � � , - : - nl2ew ❑ Add'�L: an epair,�Remr�:Icl �
<br /> ' ' � � ' - ' �' � {� ..
<br /> �� i- . � � � • • ' . � • 4aluation of Construction $S� rc ��
<br /> • . � , . .. . _ " . . iP1AT PLAN F£QUZSI_�li.::TS ' .
<br /> w. . . .. . � . .
<br /> � . . • . � . . .i
<br /> ,. ; ' ' ' . ' � ' ' Indicatc lot sizc, nar..c of sY.reet^,
<br /> . i �, .. , . • ' • rin8ica'cc 7.ocztion ar.d wicth cP i
<br /> • ,. � . • : -111eys, 'locite pr.oposeci a:.d all
<br /> ' '1 ' ...- .. . . : • .eXisting �uildi:as. shc:r z:�:;:;;nces ' �
<br /> I - •a '. -.L•o prope:�ty lines, siio�� distances
<br /> .. � .' ' �'. .s ' •• . bet�acen ouildings.
<br /> � , . _ . . .
<br /> . �
<br /> : . • . . : : bot �iz�. � a__ ' I
<br /> ' ..- ` • . Lot area Sq. PL. I
<br /> • ,•„ = � � � �Si�e o.': Pildg. Sq. Ft.�
<br /> � ` + , • • tim�bcr of Stor:ec � I
<br /> • � '•: . . • IIase:ac.nt _.� I
<br /> �.. • . �, � �
<br /> + � -�- ' . . Si9ncd Ey / '
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<br /> ' j• • . Ror � ' �_ '� � ' �
<br /> . . '� . . . . . � .. � . . 2y� Phonc ��.��--��- �
<br /> . �
<br /> � � DO ;d0: S';3?T!: 9'cL!�:7 :11I5 LI:Iii-FJR CI7'Y iJ$_i Oiii.'L � � .
<br /> : _ Detc Saceived ;i' - � `/ - � �, Ucc 7.one '`'1_ _ ^ �
<br /> � .
<br /> ' Ylan C:1ec; :;ur.,bcr �J - S �� � ' Pirc 2o�c � ' ' '
<br /> . , Yalnaiion ' -i�, 0 -- �-' • _ Occ�ro7ncy Gr.on� --�? _ L, Y
<br /> ]�cmik I'ce � l ��,' I'. ('' o:' _ � 7'yr�c of Con::irucii��n .�#y-• J\I - 1�k
<br /> Plan Cl�ec); Fc� � Q1�•' � �' Occut�;enC I,oad _ �� _ �
<br /> . iotal I'cc Du�. -•�/ �i. .' '�.. � S.�rir.l:]in-� I�ifT�X:�i.H EVERETT ' � ; �
<br /> D:�` T::J �� •• ABPROVED.FOR BUICDING FC:,t„�i ' �
<br /> : , �' ... —_'__._. . . - ' ' �ato �1 . .:'�..�._By 'I � � . '
<br /> . ;
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