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<br />� � � � � ' ' DUILDIWC PEtil�flT APPT.ICATI0�1 . � � ' ' ��'•.,�'� t
<br />- „� ;' ' ' iippllcanC To CompleLc Thia :'orm �' /`� ������
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<br />,, •• %f t¢orc than onc Uuilding is to bc cont•rur.tcd, submit n�eparatc pci•mit applica-
<br />.� tion fcr cach 6uil�lin7. A separate permit will be i::sucd Lor each Lui].di.ny.
<br />.� ;�'amer Jei�o»tie_ L. �Ir,�,�_�is J'���. ' i; i�'.;,� �, �.
<br />IIuilding Address /`�. i�' i-S7 ,- � ,.
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<br />, '. . Eddress ' " , � / � '. �ic/�st u Lot• .�.> �.. , • _-; •
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<br />. City �;��rCZi Phone.�;5_`, �:ii;S Subclivision (Plae) '�.-l�/���ii_iY :
<br />_ ' • Isrchitect/i:ngit�ccr � ,
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<br />_ _ ._f CitY Phone
<br />_ � ;,•. Contractor
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<br />� � . , ��ress •
<br />' -.�ity Phone
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<br />� � ��:� � Statc_License t7�bcr �
<br />� : . ,I E�iration Dat� -
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<br />• �� ' '•� . . SPSTCIi PLOT PI,At1 ?3EL0I�7' •
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<br />. :.1 . S'i� -1 �, a �i<,y .
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<br />-`- s "tfi ' ��� :� C'i.t�.� . . ..
<br />bietes & Lounds (Unplatted)
<br />.^,ec. � Tc�. . — R�� � —._.
<br />`Building Use � . �
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<br />�Dcscribe F7ork to De.Dane- "����.
<br />' �._.)�2�iivc•7 ).7i�.7:j�, � .
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<br />' Uce of lluildir.4 _c1i�,]/;,z j �' . '
<br />�:eca ❑ Addition ❑ Repa.i.r/Rcmo�el
<br />4aluation o1' Construction ,^• /,GC�o. ` � '�
<br />� �ry , ' � . '1'S.OT PLIsIJ R:;QOIRL'':::xs
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<br />r.. �'' �)Yl-t' Yl�l\S'�- .�`-��._'c:_..
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<br />Indicate lot �i;:c, riane of. �trectr.,
<br />�inc7ic.:c locztion �r.d ;vidth of
<br />al].cys, 'locat-c p-o�oscti ar.d a?1 �
<br />.e>;i�tinc� builci.^.cs, she�a Zi ;tar.ces
<br />S:v property lines, show fl:.stancc�
<br />between buildings.
<br />Z.ot sizc �x '.�' S .
<br />Lot area � Sq. PL.
<br />. Sizc of 131cg. � S�, pt.
<br />t�mabe: of Sto+-,tes /
<br />Basement .p'�' _ _
<br />5igncd IIY �1.. � �i � i 1..,�.1;
<br />rot J'e�����,�,c. r.. v,.��:,_;� .
<br />Oaincr Phonc , y,, �,{
<br />PO �Oi^ liZ?2'S �-LO!7.THI.•: 7,I:dP.-�OR Ci7'Y Uti_; 027L'1- � .
<br />Datc Seceived -- _ _ � Uce• 7.one � �
<br />P]an C:icc; ::ur..bcr
<br />Valvai.ion �
<br />1`c3�iti i'cc __
<br />Plan Cl�ec}; Pcc
<br />. Satal T'cC D�ic
<br />A; tc 1'�sucd
<br />Firc 7.o�c
<br />_ Occ:iuti»cy Crou�� �_
<br />--- `rS'Pc of Consl:rucCio�i `.j j.� .
<br />' _ Occuj�znt I�oad
<br />Spri.nl;1'r_rn R.: uired �
<br />. • C�TY OF E�FRFfT" -- '
<br />f1PPR4uEfl FbR'BUlLDING PERMIT .
<br />Date_i1�/-f,�I_._(3y_.1[ r .
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