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� . �� ' � ' DUILD7NC PEiiC1IT APPLICATION � , � ' � � • ' ?' e
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<br />' , , , R{�p11c,�nL- To Completc Thia :orm �'��S ' � • ��:.�
<br />If morc than onc building is to bc contructed, submit a sepat-`at�e/pecmit applica- •
<br />tion for each buiidin�. -•�1 separate permit will 6c iasucd For each building.
<br />OYLeL � � !�� � � � , •
<br />y •�-''�` '-' 8uildinq nddrese ��Q'�� 0: f:.
<br />3ddt¢Ss �/0 8 �{io._� /� �-!�u !l� Lot:?/�-'� _a -��3 Slxk '
<br />City �_-,:r�,c%`f P one��.a_; ?;t7� Subdi�ision (Plat) :a...yo !'�'�<y'�
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<br />_ )s'ehitect/Enqineer �<*4,,: �.��, � • , �
<br />_ • t• � "9j CitY /" Pt�; .( Phone
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<br />�:;�; concrsotor 1%��:lti �'���(t .
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<br />, i atY f�, ,� „� j` Phone a=��� i j 7?
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<br />•'' �'�;� � SWte,License Nw�ber %�''��
<br />, . �I E�iration Dat� � j - �,� - 7 6
<br />'��' �i , • SRETCH PLOT PL.LN HELON' •
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<br />Hetes L IIounds (Unplatted) ' .
<br />Sec. Twp, gqe �
<br />Building Use � � � �,�� • � '
<br />- ��� -��.
<br />Describe Work to Be Done � `�.� F' �
<br />Use of Buildirig �
<br />BNew � Addition ❑ Fepair/Remo::el
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<br />Valuation of Construction $�n �� B0=%• 0 d '•
<br />. . rr.oT rr.a.y �ooz���uxs . � .
<br />' Z�dicate lot size, nane of streets, '•
<br />'indicate location and width of ,
<br />• alleys, locate proposed ar.d all .
<br />exist-ing buildiags, sho:a distances
<br />. to property lines, show di�tances
<br />. between buildinqs. �� .
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<br />Lot si �'
<br />. Lot az�
<br />Sizc of B
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<br />� Sq. Ft.
<br />T— Sa. Ft.
<br />Nus.ber of scories �r,,.�
<br />Dasement -,�p
<br />Sigr�ed By /�/ (���,,,Q._.��
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<br />�or �Y;� G� ,s�_ l.
<br />Owncr Phone _ � t-�_ 7 '3�
<br />THIS LINz-POR CITY U5� O:IL'1 `
<br />Datc Seceived ��� � C=�/�J 5� ' Dce• Zone _ (� _ e_ V
<br />Plxn Chec� :7ur,bcr _% �3 - �; `� 1 ' Firc Zonc ; •
<br />Valuation 7_�= , �"•' ":� � 7,ZE�C�-`�' '
<br />Occuonncy Groua _ }
<br />Pemit Fee %�t�--- �--��.' i�-� �� C�C, .
<br />7�� - Type of Canstruction �.� - til
<br />Plan Check Fee - 7 �- •" ����'�U Occupaut Lo�d •
<br />. ; 1bta1 Fce Duc �
<br />Datc Issucd
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<br />6prinl;lcr:: IIcquired ' � '
<br />• • . ; CITY• OF EVER-- ET�-
<br />•� APPR�V�D f0f? �UIL'DING PERMIT .
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