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. � . . . 1 <br /> '' ' �� ' �' • ' nvzLniiac rr.ru�iT nrrr.zcnTzo�a ' ' �(�' �,-,�' <br /> -• • .. ;, , . . ' ..�j <br /> �� • , , � �Rpplicant To Complet•c Thi:; Form � /./,•, C�. %•y' � <br /> • • � ?.Ptwrc than onc building is to bc contrur.tcd, suUmit a r'epazatc pcimiL- appli.ta=�/� <br /> � � SSon for cach buildin�. A sep�ratc per.mit will bc i�;ucd Lcr cach bui7.diny. . <br /> ' D�rner ' <br /> • � ' ' IIuil.ding Address 1f�0� ='�l'/�1/li', :' <br /> � <br /> ; • . � <br /> , ' . Eddress ' �f:t- � , Lot %o O Dlock G��S' <br /> � �itY „^� ,_ Phone Subdiv£sion (Plat) � . <br /> _ ' • 14rchitcct/Enqinecr � . , <br /> _ ' _ '':j City • Phone I�fetes 6 13ounds (UnplaLCed) • <br /> • :,'. Ccmtzactor Sec. Twp. IIq� � .. <br /> . , . <br /> �. %. . � .�ddress � . � . — . . <br /> '. ,CitY _ Bhone 'Bu5.ld3.ny IIse .. �, �, . � . . .� : � <br /> . •ii ..�: . , . . . '�',v <br /> �'�i � Statc License 2l�raber Describe S7ork to Dc Done � '�' . <br /> � : �: '1 S-Piration Dat� • ' �31p� ,C' /!'?All 5 �f- „� �/ _ � <br /> • �� ' '•� • •� SP.DTCIi FLOT PIe.?I ?3EL0I•T' • • T�� �C•CF ' <br /> .. ..� • — .. � . . , . <br /> : : i �. , � iJse oE IIuildzng :�i 0/_' i> � i= ' <br /> `� � • . . ; ' nlieW � I�ddition ❑ Repair/Runo�el - <br /> • . � ' . � • . . :` . . . <br /> � �' _ � � � • • . • Qaluation o£ Caist•ruciion $ ?�_� �� <br /> o � , _� . � . . . - <br /> .."^• • .. - ::PYAT PL11N REQUIRI�fE..TS <br /> I 4 • • . � . . • ' . <br /> w � <br /> I . .' � ' ' ' ' � ' • ' ' Indicate lot sizc, nane of. r.trcet:, <br /> � . . <br /> � ' ! . ,_ ; , ' ' • � ' ' rin.:icate locat-ior. �at:d o:i.r_th of <br /> ' ' • • • • • alleps, 'locatc proposed a;:d a17. <br /> . ;.' . : . . <br /> '• ,� 1 � • � . • .exi�ti.ng buildir.ys, she:J di::ta:ices <br /> � i •''� � ••• - �' �O : • , ' '= . . -i:o property lines, snow distancc� <br /> • ' ! � � ' -e • , _ ' ..bet�recn buildings. <br /> : T• :. { . .' . . . . .' • ' I.ot �izc / 3 a.' x i•� . / • . <br /> � , � . <br /> • . ., • . Aot area •�;' S �:_; Sq. Ft. <br /> ' .:. - • • • . 'Size of IIldg. � � a;� . Scr. Ft. <br /> � j , ' . ' ' � I7w�bc: of 5tcrir_� �9/V�- �i) <br /> r.. :: . i . . ' Basement ,�/ - <br /> J <br /> 1 - '. . . uigncd By } � �_ �� <br /> � i, . . . . . . . � . <br /> , . . • • For . <br /> . . • . . . — Ocancr� rt�aic �� <br /> ' � DO N0." SC:2?T� 9:L0!7 TIII� LI:IE-?OR Ci7'� i)S;: Oi7L:t - � � . <br /> Datc �eccived � U::e 7.one <br /> � ' Plan C1ecF; :7ur..bc� ' ' Pirc Zoae Z ' � <br /> , ,\'a:uation � Occuu�ncy Grou� � -'L. ___ ' <br /> Ycx�ii{i I'cc � � 7yric oi Const-ruct:ion � <br /> Plan Ched; 1'cc OccuPanl T�o�d <br /> . iV�:,l I'ce Auc Y� Spri.r.l:li;r� Itcc���d�F�LFRFTT_ � <br /> n;�c s�su��a • ' •APP.ROV[D •FOR BUILDING PERMIT <br /> ' • . . .. —______ . . . " Date�7�?�'�'1''•L" By'�. C • <br /> . • .. . • .,�•, ' -� <br />