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<br /> ' „� , ; � , , • � l�pplicant To CompleteyThlS -orm � /'�����i� . � �� �
<br /> /��/D�J.,'
<br /> . • It more than one buildinT !s �o be contructed, submit a separate permit app ica-
<br /> . • : Lion for each buildin3. �1 separate permit will be issucd for cach buildinq.
<br /> . ; ' Oimer , ic �n a✓d� f! .�L�.-r ✓r �`} Huildinq Address � 2 �/`� .�A i�_d, . = �
<br /> � ,� • : � tdd.*.ess Q7I2 h�ic�c.�c,�.� f- Lot S-L• -7 .�-Sr af—
<br /> ` . . �tY �'L'✓�� Phone .337_ �`�32-Subdi4ision (Plat) - .
<br /> _ ' .:.�Sitect/Enqineer �(�r_ T�� n S n�t/ � V���T" ' . • .
<br /> _ .'l,•. ; • °c'� City .Z U�✓�'-� Phone o1-`�%- (�7/ ;tetes i Bounds (Unpl.atted) ' •
<br /> :.r . : : • . • -
<br /> - .;�•; Contractor �.Q. ��v�-s✓. d ' Sec. 'Stap, Rge .
<br /> _ , • ;, ` �' Mdress Sc r��� ' . . . . ,
<br /> � � .��; «ty Phone Bnilding Use �p� �' LY�i < �
<br /> .4� ,a;. . � . .. . i , '�i'•...
<br /> •• � ��� � State,I,icense N�aber. Describe Work to Be .Dane • ���Y
<br /> : . �I Yapiration DatB • • /L��u/ G n�� S 7`,<<Pf! O.tJ �
<br /> _ '��' � . - SICETCH PLOT PL1I BELOtQ' A'• . '
<br /> . ' • .. , - .�.1/VI� '�� ' ' �- • ' •
<br /> • � Ose of Buildirig '�N
<br /> �.
<br /> �• i • :;; 9� ' � , ; � •�jiex ❑ ]Id3ition ❑ Repair/xemo�el
<br /> • • �.i� �I . • VI` ., . �
<br /> ;• . . e . • j. Valuation of Construction $ /�G, C c C .'G o '
<br /> , •� .. .._• � - " ' ' I :. � .
<br /> �r.. . � .• ' :!` - - . PI.OT PLAN R£QUZ?2ESLNTS . : =
<br /> ��. . •. ! . . a"' . , ' � . • - - .
<br /> • '.�
<br /> � s . • j,,.. ��;�i� `I,
<br /> �y�s���� . / ' / .: � Es,, . Ii�dicate lot size, nar.ne of streets, .
<br /> � . �_ i j "� •indicate location anc wicth of � -
<br /> ���gg " ' ;,� y.- = �� �• 811eys, locate nroposec ar.d all .
<br /> ' ' .' existing bnildings, s4c:+ dista:ces
<br /> _ . i � �� �'' � /�- .. '+ �� to property lines, show distances
<br /> - � . . �• � betaeen buildings.
<br /> . . i. � � . . � ; "�• . . � .
<br /> - . . ; :�• : .. .. . - -� �r'' : I�ot size �'.;�•c. X ' j;�.v �- c� �
<br /> - . =.i- � , '41'A:�.���. . . Lot azea 00[> Sq. Ft.
<br /> � � - = � /���',l�` �;. •'� I ' � � . Size of Blaq. y.5' Sa. Ft.
<br /> . �, .
<br /> ' ' �'i -- • Oa ' . Number of Stories �
<br /> • :: - � .. . �. 8asement •
<br /> .f: .
<br /> ��',• � . • '. • Siqned � G �� '
<br /> _'' . ' : �� _� � : ,� . .._-___� For � /�Q.� ._ j
<br /> � 73' - 0 ' �
<br /> Owner Phone
<br /> � • , . ,��1��/ . . ' ' • . . : . 3 3 7 - / -r'i 3 r-- .
<br /> .,' � DO :IOT t{:i?TE Bc:,Otl THIS LZ:SE-POR CITY US OiIL'l ` � , �
<br /> . Da[c ��ceived �I I Z-�I�I 1 � D�e• Zone P-��. �.cu� 1�� �E-,`r_ ' �
<br /> ' P�an Caec:;. ::ur.ber _ 7 S-Q��� • Fire 2one � 3 ' ' �
<br /> ,
<br /> . Valuation �z-L,, �'��• � �" Occuoancy Grou2 � ,
<br /> • Pcivit Fcc C��lt�, 9�� � � qype of Constructiort •
<br /> � Plan Check Fce ��[-� 9 y � Occupant Load •
<br /> , ibtal Fce Due � SprinY.lcrs Required ' _ ' �
<br /> �, J � •• •
<br /> Datc Issucd `_� • .. ' - " • ' • •
<br /> • ;..
<br /> ' � ' ' . . . . . • . . ' .. '". �'' • " • .
<br /> , : _ ' : - . ' . . . , ,
<br /> e e � n
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