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� " ' ' DOILDItiG PERIIIT nPPLICnTIO[7. � � � ' � G� T ~
<br />" � F�,?plicant To ComplcLc Thi� :'orm , � ` �,i����; � �
<br />••' It rwrc than onc building is to bc contructed, submit n �eparatc permit appl�'ca//�
<br />,� ..: �tion for c�ch buildit:�. il separate permit will bc i::�ued 1:or cach buil.diuy. .
<br />. , � � D+ner ii'1� � v,'/r� L- /.� G. A /f.� � � � Building Acidzcss �
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<br />,� .. ?Adzess �5��;/ f"6,di7Ri5on� ���� Lot �l� f /�j ' IIxock �'y(
<br />' �• City �L�.C..rrr Phone QS ? �rY/� Subdivzsion (Plat) ✓n!-u�^� -i'-/'[�i� /��<`�
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<br />_ � ' • lschitec:/Enqittecr � �''� ('"�//l '�--'-l�- �i� -�r,,,,�> C'�� ' •
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<br />_ ' _ ._i City Phone I3etes S L'ounds (Unp1aLL-ed) ' •
<br />. � �,' Cuatractor Sec. = � Twp. ._� L Rge (' ,� , ..
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<br />-• ;..' .�ddress • ' •
<br />' -.City Yhone
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<br />���:� � S"zte.License i7i:nbcr
<br />• :..1 Expiration D�t�
<br />+ ' '~ • SP•I:TGi FLOT PI.?.?7 T3F.LOT4'
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<br />Datc S�ccived _
<br />Plan C:icc.: ::ur..bcr
<br />Va:uation �
<br />Pctvit: I'cc V
<br />Plan C:iccl: 1'cc
<br />tital 1'�c Due
<br />U: te .l' �sucd
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<br />'i3uilding Ose � . l/ / N (.- Q (.l'/}'%�'cr,,•-���'S
<br />Describe Stozk to De Done _Qc,�,yf�/Q '�' V
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<br />�` ii�e of IIuildir.g ,td/N� r�'Y �rAR T°TS �
<br />�i�ttew ❑ Addition j�lRepair/Remo�cl
<br />• •4aluatirn of Construction 5 /�i O•`� "
<br />, ::PTAT PJ.7�27 Ii.QU2�t�.:TS , '
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<br />"�:iiidicate lot sizc, nane nf. trect_,
<br />' rinct:catc location ar.c cri_cthJo�
<br />• allea�s, 'locatc propo�ed ar.d a? l
<br />. .existi»g 5uildi:ys, sho:a di�t�nces '
<br />. . -.tu prope:ty lines, show distances
<br />betwecn buildings.
<br />�i.Ub S1Z0 ' X '
<br />Zot area Sq. Pt.
<br />. �Size o£ 137dg. . ,��' % Sa. 'rt.
<br />I1wnUcr oL 5L'o+-ic:; I ��
<br />Dasc:nent �,.
<br />Si�ncd II�
<br />Por '
<br />Ucancr Phonc � �
<br />l�:iIi: 9�lAh7-THIS LI:d£-POR CI7'Y US_; OP7L'1'
<br />Ucm 7.one •
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<br />Tirc 2oic � ' �
<br />Ocr.tiu7ncy Group � _
<br />Typc of Con;truction _ � - j��. __
<br />OccuL�ent I,o�d
<br />Spri.nl:lcr^. l:r }r L � _ .
<br />• L�I`}'t dr C-t'tR[-i�--
<br />" A'FPRAVtf1 Ff�R.•P�ulLR1NG I'ERMIT .
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<br />� .�n�����. f�,iL�'i—fly— • C, .
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