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. . . , 2 <br /> • � � � � DOILDZNG PEAMI'. .��..LCATION . . � .•��.j <br /> "�—� : • . �pplieant To Comp. .te This 'orm ' <br /> , • Ii eore than ane building is to be con:.rueted, submit a separate permit applica- <br /> . tiOn !or each buildinq. 11 separate permit wi21 be issued for each building. <br /> ' ' pvo�= ���CE� -�S �/afl/.a.17/S fuildinq Address SiS�-i��� • <br /> , , <br /> . aaar�.. a�v-z ��f�vr.r� l�J� r,oe si�k . <br /> Clty �C/%. 4Aone�3 � .S � S��bdivision (Plat) • <br /> ' • �rchitect/Enqineer � _ � <br /> _ • :` '"� City Phane Netes i Bounds (Unpiatted) : <br /> "} <br /> . , Camtraetor %�/Py'Nl,ii!/k S,�C�'�i3lT/E�'s�c. '�vp. g4e . <br /> ' lddress f� �X �3i' . • <br /> ' ' � <br /> ' Citp ��ii✓ic�l//004 Phone 7,����� Bnildinq Use ��Es�, ;.:-��',. <br /> �� 6tate.License Number �f�>,(/s 7_-z33S� Describe Work to Be Done /iUSf�9��� '` . <br /> • � �i L=pization Date / '.�S�7�i . :��r �'/.f1q>•t� Gi:v.� /-�"�CG•' � <br /> �� ; . . - � SRETCIi PLOT PLAN BEIA(P' • A _ . <br /> � • j ' � Ose of Building _ /`i_`s'S . <br /> : .{ . . . . <br /> � / : _ A]`gek ❑ Addition Q Repair/Remouel <br /> � � G✓ae. . . �� � . <br /> - � � . Valuation of Construction 5 /�3 . <br /> �. • , • - . lLOT PLAN REQUZR&NENTS �/� `-Ez� . <br /> .. � • <br /> . , <br /> • ; . . • Indicate lot size, name of streets, <br /> � �� i ' . ' � - �indicat� locaticn and width c� <br /> 1 i alleya, locate nr000sed �^d all - <br /> . ,• - �� exist.ing buildings, show aistanres <br /> .: -� - - - -_ vF�.jq/p' f, i; . to property lines, show d:.stances <br /> ' ' . ��8 r � � - - betxeen buildings. <br /> ' Lot size x <br /> � - • � Lot area Sc.. Ft. <br /> - Size of Bldq. `.q. Ft. <br /> .; r' . Number of Stories � <br /> ; . �' ' � . Basement <br /> �r.. _ A . <br /> '� _:. <br /> ` ��! � Signed ey -Cl« � l <br /> . ' Por -� �/��/�JS � <br /> � � � � . Owner Phone <br /> DO NO'.^ R7IT8 BE:.Oi9 TH:S LI:7E-FOR CITY i7SE OI7L'f <br /> Date S�ceived Dce Zone <br /> ' Plan Check :tucber Fire Zone - � � ^ �� <br /> . L J :si; , <br /> Valuation Oeeenancy Group � <br /> J <br /> Pemit Fee Type of Construction F,I I�. , Z ;;�a <br /> Plan Check Fee Occupant Load �'.IT� i� <br /> . , ' Total Fee Due Sprinklers Required �r�'�"'���":� ' � <br /> Datc Issued I • _ . • ' � <br />