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<br /> '- ' � j � ' ' DOILDING PERMIT APPLICATION � � � ' .. / �.y .
<br /> - " ' . 1lpplicant To Complete This ?orm � y �/ . 'FYJ
<br /> , • � ' If more than one buildinq is to be contructed, submit a separate permit applica-���
<br /> . . tion for each buildir.q. A separate permit will bc issued for each building. 9�
<br /> . . " ' Ovpet ReRTNLR -P�-��i�S -6RIFFi�+ Buildinq Address Sr w�-e � �
<br /> � , Eddress �)UL ���KS LOt24 ��\�3o Slock '7Ko '
<br /> � City L'VL-I�CIT Fhone259-u1o'1 Subdivision (Plat) p��7 cF �=��Ec�s� •
<br /> , �..,.._.._ .. , _ - '-�-�� •�
<br /> Jlrchitect/Engineeij':,,.. ' . , ,
<br /> `"� City .�, Phone .�, Metes a Bounds (Unplatted)
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<br /> . ;, Contractor (i�1��';"'_^� (',�},iCT�:IP'(IOA1 I�m Sec. �"�-`I 7t�p.""\ Rge I�-S '
<br /> . . �, . � �i�o. — . .
<br /> . . ' Uddress 79os� S�.N� Ua N.E . ,
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<br /> ' City Hlpava��u.c- Phone �59-4.7�5' Huildinq Use I-��w o1=��cG . :`°.; _- .
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<br /> •� � ��y`i � State.License Number :1',13�n1-13(�e5� _ Pescribe Work to Be Done F;L� iN oS1<�•T '` •
<br /> • � . ;I L=piration Dat� In+ 6�1i„ �e en+�;.�u.e Gf-('icC Ar��µ.
<br /> �� � �� � S1�TCH PLOT PLAN BELOW' • Arn�e�x 8�:14 �
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<br /> IIse of Building
<br /> � � : . ' , , : � []Nrts� �.Addition Q Repair/RemoGel
<br /> � " ; • _ • � -. � j. • � 'Valuation of Construction $ ?.coc.�,- '
<br /> �"' � �� A .. � I I ' � . . P7AT PLAN REQUI?2&�SENTS . ..
<br /> ," . . . . �'�z . . �
<br /> ' � • � y _ ' : Zndicate lot size, name of streets,
<br /> � � • I'� ' �indicate locaticn aac width of
<br /> � . � 1,�1 I �� �`:'-'� - : �� '. `•I..� -. •' , alleys, locate pr000sed and all � �
<br /> • :':� �� ; . I - : ✓� existing buildings, show distances
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<br /> , , y L:. � " � ' to propezty lines, show distances
<br /> � T ,:y � _� �• � betxeen buildings.
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<br /> � ' • Lot aize ���,';� x �c
<br /> � '� � -� t:.•. � , , � i
<br /> ..- . � �+� �•,� ;'-�%� �� '. i . IAt area Y�^c5S SQ. Ft.
<br /> r.. ' a..ns�o ' Size of IIldq. 3i:uc, Sq. Ft.
<br /> � ; .. I �on,aw ` �,i Number of Stories 1
<br /> '.: � i, ' --- - - - ---=� i Basement ye�
<br /> .:. _ _. . _I
<br /> ., . PI.1CiFIC Signed By ���-.. 1Zo-,wLW�,�_-�
<br /> � • ' . . 8or I�f;i�!'s;Eu::;� C9�i�:;il�i'i�N, I:'!C.
<br /> ' � Owner Phone �,�i� i,.�es
<br /> � DO :70T F:iIT� Bi:.OS'7 THIS LI:IE-POR CIT'1 USE Oi7L'1 -
<br /> - - Date Ceceived � 7 7Sr Dt-e Zone
<br /> ' Plan.C2zeck `7a:,ber �S-Z2 y Fire Zone Z ' _
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<br /> Valuation 'G���r' Occuoancy Group � �- �
<br /> . " �� f �' Type of Construction � - }..� .
<br /> Pesnit Fee �•
<br /> Plan Check Fee �� • � � Occupant Load
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<br /> � Total Fee Due � 3 �� �" Sprinklers Requi��iY � ,-�,��
<br /> Datr. Issued ��/'.'��7`�' � � . APPROVED �nR Bj11LDING PERMIT . .
<br /> ' ' , , . ' ' Date�u:;�-�>.—l�Y �, l' , '
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