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<br />•• • ( ' ,. , . ntlILDINC P£F2MIT APPLSCrTIO[Q ,/ .� �j.. .... .��� . ,ti ��
<br />05 �•:.�' . i
<br />- ' " + ' � � . : llpplicant To Complete This :orm • / � . ,i '
<br />.. . � . • , /o%8�7s .' ; . :, .
<br />•`' xt more than one buildin is to be contructed, submit a e arafe
<br />�. 4 s p permit applica-
<br />.. tioa for each building. �l separate pezmit will be issued for eacl� buildinq.
<br />. � � Ovaex �°�Pi'�Q0'� I � AU�� �_M�, Suildinq Address ,-���� � � ;�-tta l� -
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<br />i�. •; �ddress c�� � c�. ������A ��n i q 5, Lot���% �/ �, c� Block ��% �
<br />- , City Phone{j��'�1-�,�(%S 5ubdiirision (Plat)Cf'][�y;�� Q(,� s,-(1� �
<br />: � - luehiter.t Engineer �_ -(�p �� u �;��;-� ' • ' •
<br />• `• � '°� City • Phone Metes i Bouads (UnPlattedi '
<br />_ . � ._i .
<br />:.� . , i �r��t�� . . _
<br />:�'. Contzact� �+�w� C•• Sec. 1Wp. Rge
<br />- �, • .
<br />� . � • . � • Ilddress __��� . •
<br />... �1 City ���M Bullding Use • . ;�•e ,:s x
<br />.'.`•7 .: •,:,. , . , , .�?F:;..
<br />� '�{ State.bicense N�er �-Q'j•-n/-//��S Cescribe Work to Be Done
<br />; . � ;I Lipiration nat� �-� -� 1n � ' �,�C1h1ti� � 9 9i hl� C11 1 K� �4-' . �
<br />*��' � • ' SRE2CN PLOT PLAN IIEIAli' • • � �� .� . -
<br />, :f•:� • .. . , ' . . . . .. .• . � � . _ ' . . • .
<br />Use of Buildirig
<br />a�. j � • , � � . . , '[]NeW ❑ Addition Q Repair/Remo�el
<br />. . . .i ' � . � . i� , p
<br />� ; • " . � • e • Valuation of Construction $,-� f�(i, U •
<br />'• • . _. � .
<br />•�,_• . - . , . .. • PI.OT PL11N REQUIi2E:�fENTS . .
<br />� � • -• •�- . • • . • ',:
<br />� � ' . . . . .. . .
<br />' � ' ' ' ' ' '' ' ' Ipdicate lot size, nane of �treets, �
<br />r� . �
<br />• • ''' • . • " �indicate location and widthco:
<br />• . ,i ' - ', i:; ' .- �.. _ : : • alleys, locate aroposed �r.d all
<br />' `'i • � Cxisting buildings, sha.v distances
<br />. i ! ' • . � ' - '-'! • ' . '� .'� ' . . to property lines, show distances
<br />' - between buildings. .
<br />t. i � � • -• • ' ' . .
<br />,� . ' ,.' , , • . : • ; Lot size x •
<br />� S.i- . ! • • � ' ' • . ' . Lot azea � Sq. Ft.
<br />� . r, = . . � _ ,.� �,: • ' � . Size of Bl g. Sa_ Ft. �
<br />� `s , • Number of Stories
<br />• :: .i ' . . . . • Hasement
<br />.r. _ . .
<br />4 '
<br />� �, • • . ' • . , S�9�ea .
<br />;; - • • - �
<br />.. _ . • . • For\�.�, � � `.
<br />.' • Owner hone � -
<br />..' � DO ;1C�T S�ZT_TE T1=LOC] iliI� LI:IE-FOR CITY USE Oi7L'1' .
<br />Date Seceived � Ute•Zone �
<br />' Plan C4er��:tur.ber ' ' Fire 2onc . ' �
<br />Valua:ion •a�(^(�, C'� Occuoancy Grou�
<br />• . • T
<br />Pemit Fee � ' Type of Construction
<br />Ylan Chcc1; Fce Occupant Load •
<br />. � Total Pee Due
<br />Datc Issucd ' '
<br />Sprinl:lcr.s Required
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