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<br /> ' �� ' ' • ' �Vztnit�c rr.nrtrx nrrr,zcnTzo�a ' ' ' • � :p rt
<br /> � .,� ,;' � ' , , Applicant To Complelc Thiy G'orm � '/•,��• � .
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<br /> • • ' IP uorc thon one buildinq is to bc cont•rur.ted, suUmit n c zratc PP �
<br /> '' c p. pcimit a l��n�/>
<br /> . Qioa for cach building, e1 �eparatc permit will bu is�ucd for cacli bui7.diny,
<br /> . � � 6mer ' � �' Duilrlinq Address _��0..7 /i,l'/�l/l/ ";
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<br /> � . aaaL�s� � - �,�. , r9�
<br /> . Lot To d nlock
<br /> ' �• Cit•y _^ phonc Subdivision (t�lat) � :
<br /> ' • grchitect/L'nginecr � � , _
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<br /> _ _ .�i City Plione Fietes G L'ou�nds (Unplat:t•ed) .
<br /> . ;,� Contractor Sec. Twp. gg� � ..
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<br /> '' ;- • ' .2ddzess . . ' '
<br /> !, -.CitY _ Phone '9nald3.ny Use � . . _: '
<br /> . •41 . .. � .�� • .�/ " � , ...yr"�J�....
<br /> �'�:� � State.bicc»se 2liaabcr Describe S7orA to IIc Done '�` �r' �
<br /> � : . �1 Ezr+iration Dat� � ' l�'�,C � l�?,r�l� � _y- a ?/l .
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<br /> . ��' : . .. SP.ETGi PLOT I'I.:,?I ?iEL01•7' •. . T�+'�--,(:COF� '
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<br /> . :'A . . . • . a" iise o£ L�ui2din9 — .�77J,E'✓9i�_ '
<br /> -�� � = • . . ' ' � LZhrw ' hddition ❑ Repair/Remo::el �
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<br /> ' !' . � � � • • . � • - Qaluation oS Co�istrucCion $ ,!�j7,� "
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<br /> -�,. •. , , . . ' . , :�PIAT PI.I�N REQUI_tL:C�.':S .
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<br /> . � � . . ' ' ' • ' Indicate lot size, nar..e nf. ctrects,
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<br /> ' ' ' � ' ' ' rindicate locatinn ar.d H•i.r.th o�
<br /> � '"� � � ' • • ' alleys� 'locate nroposed a,-.c? all
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<br /> � 1 � . . exiating buildir.ys, she•.J ctr:r.ces '
<br /> - i '; • ...- - ,' *O . : �..- . . -S:o property lines, si,ow distancc�
<br /> ' � � • e • . _ ' . ..bettaeen buildir.gs.
<br /> : � •. ' .• . . .' • � ' I.ot size ; 3 :�. ' x ��� • / ' .
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<br /> � .. . � Lot area �, T ;'c: Sq. Ft.
<br /> �`; .•.• ' • ' � Size of Fildq. %� a;� . S�. Ft.
<br /> ' . ' • I1w�ber oi Sl•orir_s t�NF (i�
<br /> , :. , IIasement ,i/ � ,- —
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<br /> '� _, �- '. . . Signcd BY ��_ +-��
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<br /> . . .• . . • — O��mcr Phonc 7 '"-
<br /> ' � DO NOP F:i?T; 9�LOt7 TliIS L1:dFrPOR Ci7'Y U54: OtIL'[ � . . � .
<br /> . Datc :,eccived ' � � Uce• 7.onc '
<br /> ' Pla^ Cnec,:�`7ur,bcr ' ' Fiic ?.o�c Z ' �
<br /> . �'a:u�tion Occwiancy Grou� � -1. ^�� •
<br /> Ycxni{i F'ce 9ype of Con..truct:ion
<br /> Pl:.n Cliccl; Ncc _ Occup:�nt T.oid •
<br /> . ,^�otal I'ce puc _ __ Srri.r.l:lcr� 1t����r70F EvFRFTT_ ` :
<br /> P:te x:�sucd _�T_ � ' 'APP,ROVED •FOR BUILDING PERMIT
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