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' � � � � � DOILDING PERMIT APPLICATZON � ' °'� <br />" s ' : �pplicant Ta Complete This ^orm `�'��,� �'+! <br />, •� If more than one buildin is to be contructed, submit a se arate p�/���� <br />4 p permit a lica- <br />" tion tor each buildinq. ]1 separatr permit will be issued for each buildinq. <br />• � O�ns�r f�r� t1 Buildinq Address �3�yoy_�i' i/��t//,j /(�� : <br />.' , address G��S o c / i.. �ll 1f�1_ Lot 1 G siock . <br />r � <br />City -���� Phone !� J� ,�i ��l�.� <br />� �ichitect/Enqineer � <br />`.� City Phone <br />- _ i -- <br />. :, Conizactor ' <br />� � lddsess <br />•'' City Phone <br />_ i� <br />�. �� State,License Number <br />� • .�i L:piration Dat� <br />-�' �� � SKETCH PLOT PLAN BELOi4' � • <br />• ,.j� __--� �� /� /� ` I�00{ .n,VCr.,lldfi�.. <br />� — � . '�`---' � <br />_ .I ",• :� . . <br />. . . . i . � : �-, . ��� L �. � . <br />•' Housc ' i�a�IFb ! Ht'i/�Arfd•�A��"f:' <br />._. • , � _ . <br />� , . <br />� . . , .I . r . ' <br />; .. . . � � .. . _ <br />, .•,� . i-,:,: , -. ��f. <br />� - j -� . . .� � . <br />_ � . � . . ' . . - '� .. •'� . <br />. ��' . ' <br />� �� • <br />, . <br />..:- ' i �, . <br />r 1__�`, . <br />�j <br />. .: . i� . <br />r.. • _ <br />• � , --- <br />DO NOT <br />Date Ceceived <br />9ubdivisiun (Plat) � <br />/�r/[.l ��, `��r,i/ti/ . <br />lSetes i eaunds (Unplatted) � <br />Sec. 1Wp.� gqe . <br />� <br />Buildinq Use � �{J ,: ! ,;:, .. <br />Describe Work to Be Done�'1�',�.. <br />e <br />Dse of Huildinq _ <br />❑Hew �Addition ❑ Repair/�emoue� <br />'Valuation of Constzuction $ ���f� � �� <br />PIQT PLAN PEQUIREFtENTS _ <br />Iadicate lct size, nane af streets, <br />�indicate location and width of <br />alleys, lccate oroposed and zll <br />existing buildinas, shoio distances <br />to prop�rty lines, show distznces <br />between buildings. <br />Lot size x <br />I.ot azea Sq. Ft. <br />Size of B1dg. Sa. Ft. <br />Number of Stories <br />Basement <br />Signed H <br />. � For �� <br />ner P one <br />� <br />Plan Check :Jur.,Ser - <br />Valuation "� o� - G <br />Pemit Fee l� � <br />� � <br />Plan Check Fee <br />. � Sbtal Fee Due � .° ���j <br />' Datc Issued C}-( / ¢/-� �. <br />-�--��7-�•--- <br />CITY USc OtIL'L <br />Ace 2one <br />Fire Zonc ' <br />Ocwoancy Group <br />4ype of Construction <br />Occupant Load <br />Sprinklers Required _ <br />