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<br /> " .. . ' � SOILDING ?ERMIT APPLICATZON � � ' - � � �e�, ' -'"
<br /> • . Applicant To Complete This :orm �',� ��j�•^;j
<br /> I! more than one buildinq is to be contructed, submit a se a � �y /
<br /> • , tion for �aci; build' . rat �/�'s
<br /> in , P e e
<br /> 4• 1 separate e P �it a lica-
<br /> rmit PP �j
<br /> P w111 b .
<br /> e issued for each buildinq. " " r
<br /> I . . Ovner /"' - f�rf/, /�
<br /> I , � ��`�� " " � � Building A3dress
<br /> ��%�J11'/ni ' I+2.. '� ,� :
<br /> , . MdICS! �`7/3 /19�u�n • /I � yo � �+ ,
<br /> 81ock ,�" ;�rj
<br /> C1LY �,.��•.r cc i-i- «"r,�-�� '
<br /> ��� Phone—_ Subdivision (Plat) '���,, � �,�.Z �
<br /> _ � ' Lrchitect/Engineer -C�,, / �' ' �
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<br /> _ _ _� City jy_ �� Phone •�_ [Qetes i Bounds (Unplatted)
<br /> �. � :,'. COntiack,r Cd � ,�: . . ..
<br /> , Sec. 1Vp, Rge '
<br />� _ ' _ l�ddress /v• n . .
<br /> ' ' �ty Phone .- •
<br /> Bnilding Use „ ; �
<br /> "' .t State I.icense Nw�ber -!� ..:.
<br /> • . �' '�� Describe Work to Be Done�,:,-.-;..-� ;�,; �,,; ;':q ,'
<br /> ; �i E:piration Dat�
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<br /> .1 : . . ' . '�,:.'.,:-'y, �•. �,.. .
<br /> _ � • SICETCN PLOT PLA.N BELC[�' •
<br /> : • . � ' ai "�r:.;. �^ �' . �• , -
<br /> . 1 � . ;.. _
<br /> �•�„o„ ��� y IIse of Building �,f;�,_Y
<br /> ♦. . , . -
<br /> . . , ; " ' . ; �Nev ❑ Addition �Repair/Remo::el
<br /> �' ; • •
<br /> ' ' � � Valuatioc� of Construction $ Z c:d
<br /> . • .
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<br /> . . • ^ PLOT PLAN REQUI?tES1ENTS
<br /> � : • ' �
<br /> � � '' � ' Indicate lot size, name of streets,
<br /> � • � �I " � indicate location and width o:
<br />; ' ''�{ �j � "� ' � • alleys, locate nroposed and all
<br /> - . : 't �`; • -. .. ,� . existing 6uildirqs, shctv distances �
<br /> , � -,;� a � . ^ : • to property lines, show distances
<br />' ` -� �{i ,k� gr�� .- betveen buildings.
<br /> , * � ' � . T�7 . ... .._._..._. ..� .
<br /> �' �"��'''777 Lot size�_
<br /> ...'j� � , '..i � �� a7-YuX_Ci.��a /i.� ' _
<br /> . ' - � �' I.ot area
<br /> ' ;� ��.�n � '; 3 = I � Siz�e of fl�dg�-",'--
<br /> ��' ' Sq. Ft.
<br /> � ,__�_ Sq. Ft.
<br /> � � � � ' ' ' 1 N er o tories
<br />, . „ lo f
<br /> � �. -- ��!�• .-_ _�_ __._._.,..._'_ _ 'a Basement ii,, �
<br /> � ' ' /1 I '�---` , _
<br /> � � . �c ., yf" _7c /A' w�4'e Q �,�' _? Signed By � - _ /
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<br /> � (�'—� �_
<br /> F�� c« ��� ��if�:r•� C7 C1t-�.-
<br /> • . Owner Phone 3sS`•�, � '-
<br /> s-n.
<br /> . , �0 HOT I�;i?TE BE:,OS? THZS LI.SE-POR CITY US^z OiIL'I � i—
<br /> Date ��ceived ,� '7 f � •
<br /> U:.e Zone
<br />' ' Plan Check `�uc:Ser � •
<br />� Fire 2one
<br /> iYaluation ' '���� �"�� ,
<br /> . Occuoancy Grou�
<br />' . IIeznit' Fee �---"j _ ��� .
<br /> i � � . _ 'rype of Construction
<br /> Plan Check Fee •
<br /> Occupant Load
<br />, • � 1bta1 Fee Due �� �C" ,
<br /> ' Sprinklers Required
<br /> • Date Issued •`7��_c' `� i ' •
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