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.. . � � . <br />i_: <br />. . • • . HOZLDING PEAHIT APPLICATZON � . (: ,�•, j �.�.Yt . <br />� • .� ' • : Applicant To Complete This =orm / ��'./�/��;r/� ; ' <br />� . .. : . <br />•' it more than one buildinq is to be contructed, suhmit a separate permit applica- <br />., tlon for each 6y�iT ii�3. .1 separate permit will be issued for each build.ing. <br />'/'' Ovner � � % � - � Snildinq Addzess � �,5�.� � . �7 �+t-cicc'n � J. ': <br />; ' /ddress / � 4 � �YCI � 'A .s-N� Lot '�:�,` �.`� 81ock � �/�% ., <br />. City I�.�u�� Phone �,�?-��'%i iT Subdi�ision (Plat) ' . <br />� k'C�tCCt�EIIQ1AC0I �`7'L � •Lr2iL'1Lit:� `��[ �41'�(-�. ��-r�l'��-.%1�N i"C�._�l ��/!/��� ' <br />�. � ; <br />r�,rti, ,• �� City ��>�A>�� Phone Ji -34'3J Ffetes G Loun3s IL'nplatted) ._ <br />:., . i � - - - ' � <br />';,•: Cmtractor _ - % <br />' � ;.. . �� J,ddress 1K!_�' �Jm�• � .! . <br />_ � 't' City - �� Phone ��f <br />��s � State License Nunaber <br />. . � . f�-13 =_��� % <br />r . <br />. . '1 Hc3iration DatB ' <br />..�' ' • SICETCH PLOT PLA`i BrLOTi' • <br />_ .. � <br />Sec. 'SNp. Rqe <br />Describe.Work to <br />Il^`yy.H -� ��:.ti .. <br />' . .:�.-� <br />i i -•s. , <br />. . -..i.' .. <br />• i. - �� �. <br />bne ' <br />/Lv'-t- . ' . <br />_ � • � <br />':+ :� . . • . . . , Use of Buildirig <br />.._ <br />�, i - , - . - _ . ' • �rew ❑ Addition ❑ Repair/Remo::el <br />. i r <br />' ' �''• � • • ' . � • • Valuation of tonstruc:tion $ � C C'.'4 �' <br />� !� ' ' . � . . <br />; •� � , ' .. ' - PZOT PLAN REQUI?2�`SE:1TS • <br />.�.• . } - , : : ., , . ' . - ' <br />Y . • . . ' . . . 1 . <br />` � ' ' 2ndicate lot size, nane of streets, <br />-� i . • - ' ' � • • : - •indicate location ar.c width of � <br />.� ' :' j � - � . �:: _ „ _ • alleys, locate pr000sed aad all <br />. ..� '' . ' . • Pxisting b�ildi: gs, sho:+ dis:ances <br />`' � ':..: � - r- � � • ~°� • , to property lines, show distances <br />' ' s .Z _ ....:.� " • . betWeen buildings. . . <br />. t. � . . .. . � . : - . • . � • ./ S�' � �. . <br />, ... '' r . . . �. :. <br />' . . .i. s . . . � � • ' . � ' ' . <br />. _ . <br />• r., • . .. i:. • . <br />.. i.t ' ... : . <br />.�;_ :: .i_' , '. , <br />- .,;•"" • _ . ' . <br />� ' . ' . , <br />• +. ' . ,• • ... <br />0 <br />Lot size p x � <br />'. Iot azea !i Y��% Sq. Ft. <br />.Sizc of IIldg. Sa. Ft. <br />Numbcr of Stories / <br />Hasement <br />• ��J / � ,-,. <br />Signed By � L1(�nN� '_-J% � i c.,Z,L . <br />For <br />Owne' Phone _ <br />� DO :10T tC2?Tfi 9�LOt7 TfiIs LI:iB-POR CITY i7S Oi7L'! ` � <br />Datc s�ccived �G -% S-��J ' Uce• zone r.t I . <br />� �� — S � �� � ' Fire 2one '�� <br />Ylan Chec:: :iur.Ser i <br />Valuation ��oop � Occunancy Groo2 _ � <br />pemit Pee Q-��� ' Type of Construction 1�- F� _ <br />�' � Occupant Load �• <br />�Plan Check Fee ��� <br />Toial Pec Due . ��� —� Sprinklcrs Reqvired i-1�i�- • � <br />• .. . . ' • � <br />Datc Issucd <br />' . . .. <br />m <br />. " . ••` • , . <br />� <br />:.� <br />0 <br />