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-- ' r �.L <br /> � , �� ' � � DQILDING PERHIT APPLICATION n /9 �,• ���' "�t <br /> � Jlpplicant To Complete This :orm � / / " �' • � �� ���7 <br /> . ; . , �/s/� . <br /> , • � 2f more �han one buildinq is to be contructed, submit a separate permit applica- � <br /> - tion for each buildinq. A separate permit will bc issued for each building. <br /> • ; � Ovner ����y ��-/�JS� ,�) Buildinq,A/ddress �L�/Z �q-�j�/��- <br /> , � . 1�ddress j�/� t� Jr>�,�u � t.ot Y' slock � 7% • <br /> � CiLy _ � s�� Q� phone.�2 5'�.� � ��Subdivision (Plat) f� �D� — �v. ,s� f-f . <br /> , . . <br /> _ • IIrchitECt7�EIIgineer �, � C, . /e�� f-/ �JE.C'��7- �iu. ��. <br /> • :� . `.i CitY �hone <br /> - 'j Metes i Bounds (Unplatted) <br /> _ :� Coatractor -/��/a��t C.c, ��,J�2.�/��..T.✓c.Sec. iVp. Rqe � .. <br /> - � / T�--- <br /> _' . ' 1lddress (a 5�/c� - 1 �v C'c,✓: . . <br /> . !: �ty��jl t/�rrr'd Phone 77�- L/ c�/� Bullding Use /�� 5 . � <br /> .' =�.•::-. . <br /> 41 � • <br /> � yj State.License Number ,��j UL � �(J Describe Work to Be Done � `�� � <br /> � : .I L=piration Dat� ���fj � i,� �,��,� � �� �� .. <br /> �� ' ��y � SICETCH PLOT PLAN BELOW' • � r,d�-� Kr� .�?_ = <br /> _ • . , I . • � - . <br /> • � Ose of Building <br /> � . . <br /> � .. • •�. . . . .' �Nev ❑ Addition Q Repair/Remouel <br /> . ,. ; �'—'� ,. f'`� <br /> � <br /> ' � � � . . Valuation of Construction $ j� `` " <br /> � '. . . . . . ' ` � PIAT PLAN REQUIREEI�tENTS <br /> � � � . . - , <br /> � ' � � � ' A.dicate lot size, name of streets, <br /> � � �indicate location and width of <br /> � ' � ' ' � alleys, locatc pronosed and all <br /> ��,' , ' !�.. - • • existing buildings, show distances ^ <br /> ' • "� "� /.{��5�-- � ' �% • to property lines, show distances <br /> ' ; � r �" ' between buildings. <br /> . . . ' Lot size x <br /> . � <br /> ..• ' � _ bot area Sq. Ft. <br /> �'_ r•• ' ' � Size af Bldq. Sq. Ft. <br /> ' '` �� n�� • ttumber of Stories <br /> • '�! i, �" . <br /> ;.. Hasement <br /> ,� � .-- Signed Pp <br /> . i . . . <br /> ' ' . For <br /> � � � � , Owner Phone <br /> � DO NOT {CZITS B�LOhl THIs LINE-cOR CITY USz OiJL'! � <br /> - Date Seceived Dce Zone <br /> ' Plan.C:�ec;: ;7ur..Ser ' Fire Zone - <br /> Valua:ion Occuoancy Group I � I� � : �� '+ I I �' `� <br /> Pemit Fee Type of Construction iu;��Y j �y �p�5 <br /> ' � Plan Check Fee Occupant Load ,-„rncrr <br /> �J� �. <br /> . ; Total Fee Due Sprinklcrs Required !;-�,, ('�2-r�.. <br /> Date Issucd ' • , <br /> . ' ' . • � <br />