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a <br /> _' � :. j . • - ------'- ----•-- ••-.__.......... . . ,. �. ., ,•,,�j <br /> „ , j . . ' � Applicant To Complete This :orm /�jp3 � •'; : ' � . <br /> � it more than one buildinq is to 6e contructed, submit a se a ate ���3�/� v <br /> � P perm t applica- <br /> . : tiOn for each bu'ldin�. �1 separate permit will be issued for each building. <br /> . � � QIfLtT _�/iO�CiA�oe ' . <br /> Buildinq Addzesa 2 O // �'�„�.• <br /> � . � ' � .�d// C;'�i+� ��c.. <br /> , • . /ddress - Lot �O Slock <br /> ' • �h' r� Phone 2 r`� �L� : <br /> Subdi4lsion (Plat) �,— <br /> _� ` lsehitect/Enqineer � . � , • . � _ <br /> � !ti � .t' � • ' . • <br /> : . _ • :-j �h' Phone Ketes i Houads (Unplatted) � . . <br /> - :�': Caatractor ' Sec. , - <br /> _ ;'..� , �'P• Rge <br /> : r• llddress ' . , ' • . <br /> �f atp • Phone Hnilding Use . F . j-� - <br /> '?1 . -,:.. , t >.- <br /> � State_I.icense N�ber Describe Work to Be.Done � , "�'►'.� <br /> ; .j I f5cpiratioa Dat� . . , . . • • ' .. <br /> ,,..--„�� . <br /> ,�1; '+. - _ • . . <br /> SI�TCH PLOT PL?±7 BELOf4' - ' <br /> . � �;� • . . . .. , ' � Ose of Buildiaq • . � <br /> . . . <br /> �� i � � �� • L]New ❑Eddition �pair/�emo�el <br /> - • . �d' . . • � "; • i <br /> f' � � � � . � • ;' - Valuation of Construction Do� ' <br /> , •� _ . _ � . � <br /> �� � � ' ` • ' PIAT PLAN REQUZ_TtEJIE.ITS <br /> -�. . . . ., . -' � _ ; <br /> � • ' ' ' ' � ' ' ' :.: . <br /> -' � .� � � . ' • ' � ' • ' " Indicate lot size, na�e of streets, . r <br /> � . �' i : ; .. �r . , � '� � ' i, " 'indicate location and width o: _ . <br /> • - ''� ' • - := • alleys, lceate nr000sed ar.d all <br /> ' �� � Pacisting baildi.^.qs, sho:+ diszances <br /> " `� � � . �` � ` � - .. . ' • '�~�'� • ' • . tA propertp lines, show dista-.ces <br /> i.j . . � � .. . - - . between buildings. . . . , <br /> , :�. •.. ;' ' . . • Lot s tze X • . ' <br /> ,. <br /> : . . ':.i- ! • • '. ' • ' ' • . Lot azea � Sq. Ft. <br /> ' -� . <br /> . . �� e • • .. • ; Size oI- Bl 4• Sq. Ft. <br /> ` Humber of Stories <br /> "= ' i . . . . . Sasement <br /> '`: ' % / <br /> ~����� ' • � . Signed By � <br /> . 1' .' . • . . ' • . <br /> .. '_ . . . •� • �..� For <br /> ' . ' . . , ' . Oimer Phone <br /> ••� DO :IOT SC:2T_T� IISLOt�I THIS LI:7E-c OR CZTY US Oi7L'L ` � <br /> .. ._ . _ . �- �. . <br /> . . Date Seceived � � 11' . . • <br /> , , _ _ IIte• Zone • <br /> ' Plan Cheek. :7ueSer ' ' Fire 2one - ' <br /> • ' Valca.ion fZ�O `w Occuoancy CroaQ . . <br /> Pemit Fee '��i '" ' • kype of Construction • <br /> ' Plaa Check Fee � � Oecupant Load • <br /> • : 1`otal Fee Due . l2- v� Sprinklcrs Required ' <br /> Datc Issucd '__�f,��'3i �'7 1� • .• . • , . • . . <br /> • •. . . .. • •;.. . . , � . <br /> . ... . . , , • „ •^ •', • ' • . <br /> • . ' . , . . • � , . . , • ' • � � . <br /> � • , . . • . . • -r <br />