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' : � � ' HOILDING PERKIT APPLICATION � ' ° � T <br /> � .' , ' , 1lpplicant To Complete This ^orm • �� �+� <br /> , • • �f more than one building is to be contructed, submit a separate permit applica- <br /> • . tion Eor each buildin�. A separate permit will be issued for each building. <br /> . ; ' O�mer ��c -� ' r , <br /> Buildinq Address I ;�:.� - <br /> � , llddress �9L� d oZ . (r 8 �/. Lot o� � � .'Z �d_. Block �9 0�. . <br /> ^ City 'C�� Phone 7c+ - a S�ubdivision (Plat) �"_" __""' : <br /> _ ]ltchitect/Enqineer � <br /> ' `•• "'� Cily Phone Netes t IIounds (Unplatted) <br /> - =� <br /> :, Contractor ��v,�.c.�, • QA.�.�Sec. TVp. Rge ' <br /> _ - " address 2 � 8 � 6. 99. . � . . <br /> ' City Phone 7 g 7,5��� guilding Use -'•; :_ ' <br /> ,� . .� . � , :.,.. <br /> �j State,License Number � �.3 O/- j BJ��Describe Work to Be Done � �` <br /> ' : � �i E�cpiration Dat� ' ��y�1 -�v �,. ' <br /> . � <br /> '� ' � � S£.ETCH PLOT PLAN IIELOt9' • ' <br /> . • • j • . <br /> : { IIse of Building ' <br /> ! . ; . � �New ❑ Addition ❑ Repair/Remo::el <br /> � � � � � �• � . � Valuation of Construction $ ��-�+ �� <br /> • � 2c4 � �'_ <br /> �-• ' ^ PIAT PLAN REQUIRF.}1E:ITS r •� .�'Z� <br /> .�,. . . � . . . . . � <br /> � ' ' 1 Indicate lot size, name of streets, <br /> ' I'.. _ ' indicate locaticn anfl wi�th of <br /> • ! • • � alle s, locate <br /> . :i _ . . .' •O Y pzo?osed ar.d all . <br /> existing buildi.-.gs, s'r.o:e distances <br /> - . � '� ' '� "- '! : :. �� . .' to property lines, show distances <br /> � ' � � • N between buildings. <br /> � . _ <br /> , Lot size J�6 x � o� � <br /> ••' ` , I.ot area 6 p Sq. Ft. <br /> • :.. Size of Bldg. Sa. Ft. <br /> � ' ' UI • � Number of Stories / — <br /> • �•! • i.• .-1. • Basement <br /> :.. _ \" �, /� � <br /> 1� �` r ��'-- Signed Bp CGLa.LL -�' �_„ ,:,� <br /> � <br /> � - �D�. �v� M,ay ,r�o� For _ 9�l lZs� <br /> Owner Phone • <br /> • ��s �-�`�� T/�� ����� TO �,GL� ,�.� G/,uQ . <br /> � ' DO .70T {i2ITr 3cL0('7 THIS LI:]E-POR CITY US'n 02IL'L <br /> . �" � <br /> Date Seceived (..C� !p � Uce� Zone <br /> ' Plan Chec� ::u.:,ber 7'S ���o� ' Fire 2one 3 ' <br /> Valuation Occunancy Grou� <br /> Pezait Fee � Type of Construction � -�..� <br /> Plan Check Fee O:;cupant Load <br /> . � ToCal Fee Due Sprinklcrs Required <br /> � CITY OF EVERCTT <br /> Datc issued • , � . � /�ppROVED fOR'EiUILDING PER�41T <br /> . , . , .Date�i�1-L�l.r. gy..�__C . <br />