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_�� <br />� <br />� � � ' DOILD2NG PF.RMIT APPLICATIOt7 � C/ : <br />Jlpplicant To Com2lete This :orm // '39/'.'.'i <br />• � ' • � r5��� <br />Z! nwre than one buildinq is to be contructed, submit a separate veimit a�ica- <br />tion for each 6uildinq. A separate permit will be issued for eact. Snilding. <br />/� � . , � , � )_ <br />"�'' O�mer �r /-t�»��„�4 �.��Nil�F�iti�l��i= Buildinq Address ��)`17 /1) U�G��: ��r��;��:, <br />, ` <br />, �ddress 1c),'> ��i?�=fl� Tt}�=�lG ��/LII;T._ Lot ��I Block . <br />. City _ , %.tJ�'r_I-'4 � � Phone�_'7� �� �( 2 L Sul.�di4ision (Plat) • <br />'� , i <br />' • llrchite •t/Enyinee= <:�=�: 1� � - - '�!�L!'✓��' 'r �. Ll l <br />� <br />'.:y City _ � Phone _ M�tes i Bounds (Unplatted) : <br />;, Contractor � S�c. 1wp- Rge � <br />•' Eddress . . , <br />� � <br />! City Phone Suildinq Use -r17i11 t.Y - J-! . n? �•:' : -:�: .. ,. „ <br />• �� i� State � I.ir.�.nse Number Describe Work to Be Done li,U U£ �t i.C/A/;; �; . <br />7 r <br />• '�I L�piration Dat� � (O(��r�>5 TC� �i11�,�1"l ��i�o.�vl `. h��lt-O . <br />' �' � / <br />:�' � � SRETCFt FLOT PLAN BELOSP' • � f�"d'L I-�'6'-�r� L��f= %-ID(.I�S•� <br />� ' i �� � Dse of Building i'�! 1>i�r i i'� � <br />: 1 � ���,t1,t.: �7/Lw� . ... <br />1-'; <br />• <br />,,,.. , , <br />: <br />-.... --. �_�_ . <br />_�-:_ . <br />� <br />U � ,�-�' : . . <br />� <br />• '� ; i . <br />—i. - � - <br />' � ' , I . .: <br />� � ��'�� _ . . <br />.. ti <br />`� I�Ti'�I,.�/ //��� .� . <br />°•1 <br />a��� • <br />_- �----y-- <br />.. `-U.:l�,.�t�q .Cdiiu���-- <br />Q <br />�,�a',-�� <br />��o:r1` I L�b� <br />-1- -.i i_� <br />'--�- � � I _ ���t.l�. <br />.' . .li��ir�i?-(?' .�/���10. Ii:2IS <br />i <br />Date �eceived 7 �i� 7 1� <br />, � <br />Plan C:1eck ::u.:.Ser ! �'- Z�! <br />Va:�ation ��� �� ' <br />• !/ q Lo C� <br />Pexnit Fec <br />Plan Check Fee <br />. � Total Fee Due Z�. ����� <br />/ <br />nato Is���a / q� <br />, ,� <br />❑New � Addition Qttepair/Remo::el <br />.' 'l/ _ �v, <br />Valuation of Construction $ (/l�U� � <br />PIAT PLAN REQUIR&�lENTS . � <br />Indicate lot size, name of streets, <br />indicate loca:ioa and width o: <br />alleys, locate propo�ed ar.d all - <br />existing `�uildir,qs, -how di�tances <br />to propezty lines, show distances <br />between buildir.gs. <br />Lot size x <br />.Lot area Sq. Ft. <br />Size of Bldq. Sa. Ft. <br />Number of Stories <br />Basement <br />Signed By <br />�,For <br />Owner Phone <br />CITY USH ORLY <br />Uce Zonc <br />Fire Zonc <br />Occuoancy Croup _ <br />4ypc of Construction <br />Occupant Load __ <br />Sprinklcrs Required <br />. . <br />