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<br /> -- . .. t �. . . . nozLnnac rs�u�iT nrrLxcnTru�a • • . • . , ,> .T �._
<br /> ,. . � . , � 2lpplicant To CompleL•c This :orm , ' /� /�.�� 3�'�:,i .
<br /> � If morc thon onc Uuilding i� to Ue coniructed, submit a .^,eparatc pci-mit ap�icn-
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<br /> . . Yion for c�ch buildin3. �1 separate permit will be is�ued for caGi bui].ding,
<br /> . � � 6mer 1�,�: ., �. � �, • ��I��'�t t- . ,
<br /> - IIuildinq Address � "Z J/ z
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<br /> , � .. . Edaress � r 2 _C ���� 1�,�. Lot �O�';U,14 �z�niock (.-3{-.
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<br /> ' , � City �—,�;,:� PhonelSL-7t`)/ � ' t ' ,
<br /> ' .,ubdivision fPlat) {��_•N.��'� �.. ��
<br /> _ ' � ,b�rchitect/�nqinccr ' .
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<br /> - � - '"j �1LY�\�Phone �_ bietes L I3ounds (Unplatted)
<br /> � • �,' Contractoz� � � % • ..
<br /> _ '�� • � .. .^,ec. � ��, R�� � •
<br /> • ;. . � Z'3dress � . .
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<br /> . ' �. -.City �Phone 'Bui.lding Usc �
<br /> �'��� � State.bicense 27i:r�ber Describe S7ork to IIe .D�ne �S f „ '
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<br /> � .: • , .1 �,irabion Dat� :!L��-,,:.�-� .�..: ��,.:1'. .L i -<�.�_, l_.: � :
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<br /> _ ' � ,� . • SICII'LCFi PLOi PL:.}i �3ELOf9' �. .`��1...� ��.,.�... .1....` ... � . ` `�•.-•.` ,
<br /> j •t�c._ J _2. (._. 9„_.;� w�r t.�.�,��6.t_ -
<br /> • �--� Ul' � �.l.'._. r_`
<br /> • ::1 . . . • . . se o" f Duildin4 r .-;;.C,,_:�., ��� '
<br /> -`' • : : . " : L1rew ' �",
<br /> , . ., . . �,' , . � , ❑ Addition ID Repain/Remo;;cl �
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<br /> � • - . � ' ' • � • - . [*aluation of construction $ < <�%�' • �•
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<br /> �: !. . , . . . . � _:PL'OT PLRt1 REQUI_T2L�:...TS
<br /> � , . . .
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<br /> '. ' '� i . � � _ � ' � ' ' xndicate lot sizc, nar.ie of strcets,
<br /> . ! �- ,. .: . ' • ' ' •indicatc locati ,. �
<br /> ;. : on �ar:d wic_h p�
<br /> • �•'% • . ' • ; ' alleps, 'locatc proposed ar.d all
<br /> - "� � .. - . - - w � . •'":. existing huildings. shc:i distaaces . .
<br /> � � ': . ' ' • . • . -.S:u proper�y lines, snow distancc:;
<br /> � 4 • - bettaeen buildings.
<br /> ' * • • . ' ' Z.ot size X .
<br /> ' . .. . � . .
<br /> _ • Jot area Sq. PL-.
<br /> �; •:. . � • ' . 'Size of blcig. . Sa_ Ft.
<br /> - ' ' 1tuL�bc: o:: St-or.tr_s '
<br /> . ' :. . . .
<br /> :.. ^ ' ; • • IIase:nent �
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<br /> - - . Si9ncd IIy _� ,/- _• c_L 1 ./�_.�. .�._'
<br /> � . • ' � • ' ' For � .
<br /> , ' - ._ ' UcmeL Phonc
<br /> , � � PO .�'Ol S�ZTTT' 'J?:.0!9 T!(IS LI:]iS-�OR CI7'Y i]Si: OtIL'1 � . � .
<br /> Date `;eceived ' • ' �
<br /> . - � Use• 7.one �
<br /> ' Pl�n C:icc7; :Iur„bcr ' ' Fir.c Zonc - �
<br /> . �'a2uaLion � Occuo�ncy Grou� �` .
<br /> Yczniti Pcc • •' —"
<br /> . . , , � '1yPc �,L Consl•rucCian
<br /> Plan Cl�ecl; i'cc ^ � OccuP.nl• 7,oad
<br /> . . , SUtal F'cc Duc ` Spri.nl:lcr� lt�.�quirecl '
<br /> D:tc T:;:u.:d • . • . — -
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