Laserfiche WebLink
i <br />` • ! � • - ' . - l02LDZNG PERMIT APPLICATION • . . . � • / �7 � �{ _ <br /> � • ' , �pplican! To Complete This :orm / / ����� <br /> . . Y/�.iX�j�- <br /> , • Si eore than one buildinq in to be contructed, submit a separate permit applica- <br /> tlon for each building. A separate permit will bc issued for each building. <br /> � / <br /> . ' ' pvner �/��i�T �<<"� '-S Dnildinq Addresn � .�:J/C � iIJ�j7,��'�-' : <br />, . ' , lddress ol /c' i //7/�i"�"� Lot /- �/ 91ock CC' � 7 • <br /> . City �F' /7 Phone:�5�2 ��`-!v 3ubdivision (Plat)���f'/�.,+n.� C C'��/���r� <br /> . <br /> ' • �schiteet/Enqineer � • <br /> _ • :_ '"� City Phone Ketes i eounds (Unplatted) � <br /> 1 .. <br /> , Oontzactor ' Sec. 1Vp. Rqe � <br /> - , . , �ddress ' � ' <br /> ' City Phone Snilding Use -'::� � <br /> , _ �' ..i....:�r. .. <br /> �� State License Number Deseribe Work to 13e Done 72 �� ��<:,� -�' . <br /> � : . ;� L=piration Date ' 1/L �C"C%jYZ �%�i-'� � <br /> . <br /> :� ' � . � SICETCES PLOT PLAN BELOIQ� • . <br /> . . � � • , . <br /> ' : � . Dse of Building <br /> ♦ � . ' . �New ❑ Addition Q Repair/Remociel <br /> � • . . .; �� . • . . . � . . { <br /> , '' ; ---�-�-: ' Valnation of Construction S � <br /> �,._ • � � ' ' . . , • � . PIAT PLAN REGUZRE.+fENTS � � <br /> : . j . � . ° '� I <br /> ? • _ �., �,c Indicate lot size, nane of streets, <br /> ' � ` �,� ' �indicate location and width of <br /> . � • ' (� �`, � alleys, locate pr000sed and all � <br /> • �• . � �'. `V.� � existing buildings, show distances <br /> _ . ; � ' ' ' .'-v yv ..r. . . to property lines, show distances , <br /> � • � r�r • between buildings. <br /> ` ; . . . <br /> , , . � <br /> � � Lot aize x <br /> ... . ' Lot azea Sq. Ft. <br /> r, = __ Size of 8 dg. Sq. Ft. <br /> ' i , • Number of Stories <br /> . '.; . i Sasement <br /> .•.. <br /> •. . � Signed Hy �4 ' �;s,�.t� t--t^ � i <br /> �' //'���/L`'. � . !oz . <br /> � � ' . � � � ' � � Owner Phone <br /> � � � DO NOT Sr:2ITE B=LOI•7 THIS LI:IE-FOR CITY I1SH Oi7L'f <br /> .. Date Seceived �l—— ZZ �] S IIte Zone <br /> .. ----� • <br /> ' Plan Check :7ur.,Ser ' Fire Zonc ' <br /> Valnation � UC� � ���''-- Oceuoancy Group . <br /> , �_ <br /> Pemit Fee `��_ Type of Construction <br /> .' Plart Check Fee Occupant Load _ <br /> /� �-�_ ' ' <br /> . ' Sbtal Fee Due � � Sprinklers Required <br /> • � . <br /> Date Issued 2 2� � � , , . • , <br /> . <br /> . <br />