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,• . • ! . ,. . • ' DUILDING PEItMIT APPL2CATION . •- . �X..-t. . �. ,y x�. .__,
<br /> _' � �• i • � . . 1lpplicant To Complcte This :orm � �" •:�� : 'i '
<br /> .. . ; . • ' • � ' �d�^3��
<br /> , • • u more than one buildinq is to be contructed, submit a separate permit a�plica-
<br /> . , tioa for each buildin�. .1 sep�rate permit will be issued Eor each builcling.
<br /> . ,.-� • 1., .
<br /> . . ; ' O�mer .`'19_),-�-�� � ���4 � Buildinq Address ��-�,-�T1 �! ( � �/'v�t.� 0 d
<br /> ; ' • � 3ddress ��T) (..� (��//n 1/¢. Lot Block '
<br /> . • ' . City�(�Pf�O� Phone{�„�i�,{-,"j.���j 5ubdibision (Plat) • .
<br /> ' ' 1lschitect/ nqineer � � ' ` ' � '
<br /> \
<br /> _ !,L :, .`c'i Citp � Phone Ketes & �ounds (Unplatted) ' _
<br /> � ' � -1 ' - � 9.LQ9_1�:G Sec. Twp, Rge . .
<br /> :' :�'. Coatraetor �,l ) � ' � �ya�-
<br /> . ; ...� . �--•--� . .
<br /> �. �:;�. . t. �=�=5 �== 4� u�. �� t��� . � - .
<br /> .. '�- City(,�C'119v_�- Phone�l��-� � � Bnilding Use • • . "e ' : �
<br /> ' �� . . -��,,,.., ..
<br /> .' i .: • •�•• ' .,.... "r
<br /> '�;{ State,bicense Ncnber c7�.��-O/-%�"�� Describe Work to Be Done I���
<br /> � - '1 Expiration Date �-/�:�� ' lUtO `�,'('Y',� ���.IYY\�� •
<br /> • . ( . T
<br /> - +.�' ' � • SRETCH PLOT PL1N BELOf4' • .
<br /> •.. ' �I� , � ' . . . � ; � Oce of Buildinq �
<br /> �•' ' . - ' ' , � . „ • �New ❑ Addition ❑ Repair/Remo:iel '
<br /> _ , ;'
<br /> � � •'�. � • � , � . • Valuation of Construction $ � � �
<br /> . . � . i
<br /> ',+..- • �} � - , _ ..� . . " _ - ' • . . PIAT PLHN R£QUIR&•L:ITS . ' .
<br /> 1� . � . • . ' . � . . �.h
<br /> � •_ ! . . • . � . • • ' SDdicate lot size, nane of streets,
<br /> •� � - . � ' •indicate locat�on an8 width of -
<br /> . � , 3 • � " i'= - �., _ • alleys, locate Droposed aad all �
<br /> • :•� � ' � . ' ' ucicCing buildings, sho:+ distances
<br /> (�� . • ,��.:•�-• -- y ; . . ' . . .�': ' - . to property lines, show distances
<br /> ' . � : - .; � ' _ - , betwecn buildings. •
<br /> . . . � �' . � Zot size x ' . .
<br /> ; • ', � , . �. .
<br /> ' • :.i- , � • . • " " • • . Lot area � Sq. Ft.
<br /> ' , r, S . . ... • ' � . Sizc of Bldg. Sa. Ft. �
<br /> ' �i • - ' Number of Stories
<br /> . • :: . j � . � . . . • Dasement
<br /> r:. . . .
<br /> '_ -:"` . ' '. Signed By �
<br /> �. . , , . . ' \ '__�
<br /> . '. . � . • � .. For` i� ?-{�-����_�.1 .� A _
<br /> • . ' � Owner L lion-�� _
<br /> .. ' ' DO :IDT StiZ?iL' D�:.OF7 TliI� LI:IE-cOR CITY USE Oi7L'f ` �
<br /> Date �eceived Use• Zone • , �
<br /> ' Plan Caeck :7urber ' ' Fire Zone '
<br /> �� .
<br /> Yaluation � �� !`� . ���� Occuoancy Gzoup
<br /> Peinit Fce � ' Typc of Construction
<br /> Plan Check Fcc Occupant T.oad
<br /> . � 1bta1 Fee Duc Sprinklcrs Required � .
<br /> .. . . . . . , '
<br /> Datc Sssucd ' , . • . - �
<br /> • . . . •,. ' • • . .
<br /> • • . ' � , .
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