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� .. � L.,_.. . .�- . (� '7 <br /> • •• { • Applicant ITo Complete This :orm • /' � �v 'F 'i <br /> . • ' 2f moce than one buildinq is to be contructed, suhmit a �eparate permit appli��/>/ <br /> � , , c:�n for each buildin�. �1 sep r�te permit will be isssed for each building. <br /> . • Qvner �i�li.;j �. �// C(,C�//1J/� Suild3nq Add=ess ��j"�%f � ��L'�;�/vc= <br /> • , r , <br /> ' a 1lddress ��L� f�c°..(!`_, ,/��'idc� PIiC1�S ItAY VICI�� 7'RACTS <br /> • l4LK 000 D-01 - <br /> . City �-G�('/c'f� phone���� -� �Ai.t. OF I.0'C 5 �� VAC S'1' LI:SS Ii 120P'1' <br /> . AI.50 LIi55 S GPT TIIOP 'CO CI'CY OP f:VL•Rli'I"I' <br /> ' • architect/Engineer ' 1'G11 S!'7U 8�12/520 <br /> `_'� City . Phone Metes t Bounds (Unplatted) <br /> `_ . . ; . . .. <br /> � <br /> ' :�' Caatractor ��'�� ' Sec. 7Wp. R4e <br /> . , ' , . <br /> - :. . . ]Iddress . <br /> �ir7 • ' <br /> '? �tY Phone IIuilding Use ���E� � "': -�� � <br /> .�� . . <br /> " �r' �� SWte.License Nc.aber Describe Work to He Done . .` <br /> � . � K�'�� LYpiration Dat� ' ^���� '�r� ��n/-'�/ <br /> �� � 1 '�; • SRETCfi PLOT PI,�1I IiELOIJ� • ` , <br /> •'.".� . I�• � .. ...�.+_.� � • � � ��P��� /\Ci��'+t17 . <br /> 7 �• IIse of Building <br /> :q . . . � • .. . <br /> �. ' ; • ' , ': : .' � � ' . , _ • �New �Addition ❑ Repair/Remo::el <br /> _ ' � . , • �s��s".�L_G=. <br /> ; � x�.. <br /> �-�: • /� � �.���•} , . . - � {Ialuation of Construction $ <br /> ., •� � : I. <br /> � 1 f ' ' rl . ' ' . � . PIAT PI.F1N REQUI��L,ITS . . <br /> w:_ � �rjOt�lio :.. •_� . . � <br /> � < . . <br /> �' � Indicate lot size, na;.�e o� streets, <br /> � •' .,i . � �.� ' •indicate locatioa ar.c wicth of � : <br /> jf . •- • : : ' � � allcys, locatc pr000sed ar.d all <br /> _ ;..: ' � " - � existing buildiags, sho:a distances <br /> ':_ r',� _ ';��-• -_ .� : i :;' ��• , .. : . . to property lines, show distanees <br /> . ' between buildings. <br /> • , + y <br /> _� . . . . • . Lot size x <br /> � ' ' � • • . . Lot area Sq. Ft. <br /> � ' � � . Size of IIldg. • Sa. Ft. - <br /> :j r. L� .!I s � //J� • Number of Stories <br /> • . i � �\ . �. • . . . <br /> • .� Sasement / <br /> i.. _ / � <br /> • igned y j �/� " � ' `" <br /> ` '�. For � <br /> ' � • Owner Phcne ._ •;S-= - <br /> ' UO :10T ��:Z?TS T�'_LOtl THIS LI:JE-POR CITY USB O2IL'L <br /> Datc �eceived U�e Zone <br /> ' Plan Chec� :lur.Ser � S^^37 � ' Fire Zonc 3 � <br /> Valnation `�}'�,�� �G Occuoancy Grou� �__ <br /> ' L� <br /> Y.mit Fee �Z • � � � Type of Construction T — 1—t•_ <br /> Plan Check Fce � � ' � Occupant Load <br /> � 1bta1 Fee Due . � Sprinklcrs Required . � <br /> • , CJTY ��— <br /> Datc Issucd 9 , • .� /;ppROVED ,�OR EUILDING PERMIT, • <br /> - . .. .• <br /> .. . Date '° ', '` �S—'�_By ✓s'C,�__.— <br />