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<br /> i �.�u'LLa l�rc411�H11Vtv . . , .y .
<br /> -- , „ � . ' . : )1pp11cantVTo Complete This :orm . �' ' �, � '• .
<br /> „ . i .
<br /> ' ' "li moze than one buildinq is to bc eontructed, submit a separate permit applica-
<br /> � ;� ; tion for each b ilding. A separate permit will be issued for each bu:.ding.
<br /> � , �j
<br /> � . . ��_ / / �) � yj �� S f'� Buildinq Addzess ���� % � h `(� '
<br /> �
<br /> ,' : � 21Z JC . /�'' '��- �e // si�k U�'�� - .
<br /> � . . 3ddress ' � � ,-/ :
<br /> . �� , 1/,��-- Phone SubdiVision (Plat) �'� f rr-�C L�. • .
<br /> . .` , , �; i'I...0 •/l� .
<br /> )zchitect/Enqineer ,
<br /> � ' � Metes i IIounds (Unplatted) ' '
<br /> . r, ' `°j City • Phone ' . -
<br /> ._ . .` . . . • .
<br /> �' � • , � ' .,;y Sec. '�P• R9e .
<br /> v: L `'
<br /> ;• :�•: Caltractor � ' ;
<br /> ' ;, • '' l�ddress ,l���Z''i � l'��/�!��"- ' ' ' / / .�
<br /> _ .. ' �!/? "�� �C� Snildinq Use � ��� ,� ii �l . ': �`-*_;:�
<br /> �.'! City Phone �� % , .
<br /> � /� _ . • -�,"..�
<br /> :41 : �tate�,i�ense l _ �;U(,' /l7- ,S`i y� Describe Work to Be.Done , .
<br /> . ,� � � � � � �/�: � � �I � � ���, l-� � � �.-e_� �
<br /> ���r �Y `� �
<br /> . , '� Ezpiration Dat� . • _
<br /> �,1� '• � • SRETCtt PLO PLAPI BELOSP' .. . . , .
<br /> - ::�'.:� • .. . • . � IIse of Buildirig -
<br /> . . ..
<br /> � , � . • �New �Addition ❑ Repair/Remo�el �
<br /> ` j . :�. . .,. � i ri� �. �, _
<br /> , , �,;' _ . „ .. - - - ' , ';• . t►aluation of Construction S_"7
<br /> . �. _ � j .. ? .
<br /> ; '� . ' - . ' •• ; � . . PIAT PLAN REQUIC&`L.ITS ' s .-?
<br /> �. . �r - ..: .�:- :., , , . �� � . .
<br /> '� •' - . . , . , ' • Zpdicate lot size, name of streets,
<br /> � � � ' � � '" � � • � � ;� �"-indicate location and width o�
<br /> : � '
<br /> '' ' .� : �: . ' ..��'�.'�.-�-L alleys, locate oroposed ar.d all
<br /> - � � ' � �-: ' •' - • cxisting bnildiaqs, sho:+ distances
<br /> • �'� ' ' • �+y � to property lines, show distances
<br /> _ i '; •�"`�� � ~ ' • . betKeen buildings. , ,
<br /> . . +. :I , � � .. • '
<br /> Lot size x
<br /> • .� ' .', • - �. . • . . Lot area ' Sq. Ft.
<br /> . i Sa. Ft.
<br /> • S.i' . . . ' • . ' . SiZ^ O£ Bld9. _�_.
<br /> • , ` �. . . : . ' '' . . Number o�tories
<br /> .!� ` .� • Basement ; � �
<br /> ' • •: - i � �. . . � � Y . .
<br /> �.:.,` _ ' • ,� Signed Bg. % �c ✓".0 �i
<br /> , .,. • . . . . �
<br /> + _. • . , , � , ,
<br /> _ ;. • • . ; . For � �
<br /> .. . • � � . . � Owner Yhone �_
<br /> • � ' DO :IOT t�:iT_T� B�LO('I THIS L=:JE-i0R CITY ❑S O2IL'1 � . , .. .
<br /> • _ �, n. ' Uce• Zo.ie •
<br /> Date ��ceived !v � I � -
<br /> • - - -� �,�_�< ' Fire Zone �
<br /> - Plaa Chec:: `:uaSer . •
<br /> . Yalaation -"� �l � . ��' � � Occuoancy Grov� l —
<br /> • • ' � �•� � , � - • �Type of Construction ��� - �-� -
<br /> Fesnit Fee •
<br /> Occup�nt Load
<br /> • rPlan Check Fee � � . . •
<br /> � '� �j, � ' Sprinklers Required .
<br /> : 1bta1 Fee Due =� • • . ' � .
<br /> ' .. • •//�3�75� . .. . •, , .GjTY OF' ��'ER�TT .
<br /> Datc issucd — ' �AP�'ROV�D FCC?�;2��3UILDING P[RMIT �
<br /> • ' • . ... . , . . . . •. . . .
<br /> � , � , _ , . Date ��•�=��_�`--. By_�l�_, • ' 1'
<br /> • -
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