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<br /> _ • } ' , �• • ' ' ' aoxr�DING PERMIT APPLICATION ' . � �.��-• J'i � �. i,+
<br /> : Applicant To CompleLe This :orm ���• ' �
<br /> .. . � . • • , � � ,i^�f.' �
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<br /> , • ' If more than one building is to Ue contructed, su'umit a separate permit applica-
<br /> . . tion for eacl� buildin�. .1 separate permit aill be issued for each 6uilding. .
<br /> . . ; ' Ovaer �G.Y�R ENCE • F ,e /n/ Huildinq Address � 2 �ZO ��,(C�`, : '
<br /> � • ; tddress a?I�/� (��-�rE-� Lot ��ya �c,f 4 Block �-�'7 .
<br /> . City �✓�RE r r Phone Subdi�ision (Plat) . •
<br /> _ ' • Ltcliitect/Engineer • �,,,� � ' . � ,
<br /> 1_aQC'� -
<br /> • '+ �•. `c'i City • Phone Hetes 6 Hounds (Unplatted) '
<br /> _ � -� .
<br /> , . . : ,D^ . • _
<br /> ;,•: Cantractor ���QeT 'Oti�i cJ,EtZ�S Sec. 1Wp. Rge � �
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<br /> �. ' %. . '� Eddzess .gle0lo ,Ev�'RGRF .v �'GIiPF' � . . •
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<br /> .. City Fb,cRETr Phone ,3i 3- �/(o/ Bnilding Use ��•; _:;,• _;
<br /> •�t ,:. . . • 3oi- PN . . ..,..,..
<br /> � �'�{ � State_License Na�aber „?23-p /-EU-fR-BgDescribe Work to Be Done �ERpoF `�.����
<br /> � : . ;I Ezpiration Dat� � - / - 7 7 • ' • `
<br /> '�� ' • • SRETCFt PLOT PI.T�I BELO[4' • '
<br /> _ J '� • . . ' .• . . . . .. � . , ' .
<br /> Use of Buildirig
<br /> �' . � � . ,,, � � �New ❑ Addition Q Repair/Remo8el
<br /> :`
<br /> � � ;• " . • ; • Valuation of Construction $ /��G y •
<br /> '� . . . . . . . ` _' I . .
<br /> „�• . + _ . .- . .. - ' PIAT PI.AN REQUIRE.�tE:7TS . -
<br /> � . . � . .
<br /> � . . . e
<br /> ,• i • ' � ' . ' � ' ' ' Indicate lot siac, nane of streets, �
<br /> • '' ' ' ' • " •indicate location and wid:!� of
<br /> • • � � ' . �• ' ^ .. _ . • alleys, locate pr000sed a.^.d all � '
<br /> ' '� � er.istin buildin
<br /> t.� , � -'�" .•_. "- '! ' : . . ' . .�°- ' . . to property lines. �show�Jdistancess
<br /> ,. 3 ; ' : � ' , � betMeen buildings. .
<br /> . . ' . . . . _. . .
<br /> .� .• � ," , • . . ' : IAt size X • .
<br /> � i.i- s . . � • • . ' . Lot area ' Sq. Pt.
<br /> � r.. = . . .. • ' � . Size of Bldq. Sa. Ft. �
<br /> � � `f , '. - Number of Storics
<br /> ' - -. • i. ' � � • �� - ' � � � Basement � �
<br /> �r.. . • • .
<br /> .�
<br /> '� _: , • . . �'Signe y �
<br /> . +. • ' ' • • �
<br /> • - � . . • ' For �ti,
<br /> .� - . ' - Owncr Phone _� ,- � -, �
<br /> .. ' � DO :70: Si7?T� BELOF7 THIS LI:dE-20R CITY USB Oi7L'! �
<br /> : - _ Date Seceived Une Zone �- � ` '
<br /> ' Tlan Chec;: _7ur..Ser ' ' Fire 2one '��-, ' �
<br /> Valuation ��%��D � Occunancy Crou� '
<br /> Pemit Fce f /, �1�,.� ' Typc of Con�l•ruction
<br /> Plan Ciiccl; Fcc Occupant Load •
<br /> . ; Total Fec Cuc _ � / � � � SprinY.lcr, Required ' _ .
<br /> Datc Tssucd 1 � 7'li � • • , � • � ' _
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