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� <br /> -- � , � BOILDING PERMIT APPL2CATION � ' • '? �� � <br /> ' „ . . . Applicant To Complete This :orm : �. %C a1 <br /> /3 5�..�: <br /> , If more than one buildinq is to be contructed, submit a separate permit applica-�!/ <br /> . tion for each building. A separate permit will be issued for each building. 77f <br /> • � � O�mei ,nnn�cl ry�f)�6nMF=7V Buildinq Address <br /> • -2A- ? `I �"i� 1 r, . <br /> . . Ilddress ��7- -��I�A !�1h Lot i3 " � _ Hlock �? -] • <br /> �LY �=-�1f=Dr'1T Yhone Subdivision (Plat) -�.� ��-r <br /> , � � Erchitect/Enqineer � <br /> . :,. <br /> ' :..I • � . � .1 _ ,. �—� � , <br /> - - =� �itY — Phone — tietes i Bounds (Unplatted) <br /> -. :, Contractor �� �1N 1t=� Sec. 1Vp. Rqe � . <br /> . � _ 1lddress ��',Z ra i F i .���C • � . . <br /> �. �tY t�" �!c2�.?I' Phone ZSz� guilding Use �p�7 n � <br /> '� , --� -G�� •t :�• , <br /> �• �,� State License Nuenber ZZ3 -p I - ��Uo'�i�escribe Work to Be Done � <br /> r— r i�c�� '* <br /> : �I �piration Dat� � - - � `. ' F�J v(2 � �7-R �1`j f.�T��� <br /> . `�, � , • SICETCH PLOT PLAN BELOW' • �1 JU _ <br /> . ' I . . � <br /> :;j , . Ose of Building • <br /> � ' • � - • . l�New <br /> . . L ❑ Addition [�tepair/Remo::el <br /> � — -'-- - � • Valuation of Construction S_ SUU: � <br /> • laL��`I " <br /> .+... �. -- _ --.- __ . PIAT PLAN REQUIREb1E�T5 . . <br /> ti � <br /> � .� ; � IT • Indicate lot size, name of streets, • <br /> �Aep,� (� indicate location and width of <br /> � - I - alleys, locate or000sed ar.d all <br /> _ 1 D �.� . , .. , existing buildings, show distances � <br /> ' �w- to property lines, show distance= <br /> .'.' '. ' <br /> `EVEL��D � ( ; • betveen buildings. <br /> � .ST�.E�1E�T/,d EN�j i /'�U$� � �� Lot size X <br /> ... : <br /> : � Lot area Sq. Ft. <br /> .� '" � ' Size of B1 g. S Ft. <br /> � • � Number of Stories q� <br /> . '.: . i. <br /> ,;. • Hasement <br /> �� �' ~ Signed By <br /> � ; <br /> � ' For _V�AB�L U��nt2y. <br /> , , Owner Phonc <br /> , DO NOT [2:2?T' B£LOIQ THZS LINt^.-cOR CITY US2 Qi7L'i <br /> Date �eceived ���j_[�,�7(^ Uce Zone <br /> ��-� <br /> ' Plan Caeck :Iur„be: Fire 2one - <br /> Valuation �� ��� ' <br /> ticcunancy Grou� <br /> FemiC Fee �� �v " <br /> Type of Construction <br /> Plan Check Fee Occupant Load <br /> . ; 1bta1 Fee Due S� �v Sprinklers Required <br /> ' Date Issued • � 7(,� z�� ' • <br /> � <br />