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� DOILDING PERMIT APPLICATION � <br />� . kpplicant To Complete This ^orm %9/ j����3 <br />� ��'/� <br />I! more than ond buildinq is to be contructed, submit a separate permit applica- <br />tion for each buildinq. A separate permit will be issued for each. uildinq. <br />�/ ' <br />�e! l �' �� y �-� '% � �� � "�_ Huildinq Address r�,,,, e <br />llddres/s ��-/JiJ�� /�'�'z`i�`�� Lot � � `'' Block [J �� �3 <br />, City �'�^ �.. � Phone?ti�,' 7-��-C' Subdivision (Plat) ���t�tt� r-f-�_ . <br />IIrchitect/En�� I S< '-!"i�/,(�ri/k�r <br />, . Nr,� cc/S <br />City Phone � 5' 2- Sr/5' <br />coetraator <br />1�'�L � , <br />]Iddress ���.,� , L � <br />�tY Phone <br />State License Nw�ber <br />Lnpization Dat� <br />SICETCH PLOT PI.AN gELOW' <br />a <br />�• <br />Iietes c Bounds (Unplatted) _ <br />Sec. 11,+p. Rge <br />Building Use � <br />— -� �. <br />Desczibe Work to Be Done -, .�.,,�1` .��` <br />. � Y�J � ���/ <br />L1/Y�.(rl�'Y��LIv � � ,� ' <br />Oae of Building <br />� <br />��w ❑ Addition ❑ Repair/Remouel <br />� Valuation of Construction $ ���Jj�'"�� ` <br />� <br />' . PIAT PLAN REQUIRF.MENTS <br />Indicate lot size, name of streets, <br />' indicate location and width of <br />alleys, locate proposed and all � <br />exi�ting buildings, show distances <br />- to property lines, show distances <br />. • between buildings. <br />B`lOt7 <br />Date neceived •;� /.� /��- <br />�_ac�_a_,a_ <br />Plan. C:iec:: :lur.,ber 7�"j--2%(p <br />Valuation LB�p. � <br />Pemit Fee /�• � <br />Plan Check Fee <br />Toial Fee Due !0. � <br />Date Issued <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldq. Sq. Ft. <br />Number uf Stories <br />Basement � � <br />Signed By � <br />..��� For _ //�C! -..s,�s-- (��r ���n� d <br />Owner Phone � j Z y- �7 U <br />� p � <br />.I:IE-FOR CITY USE Oi7L'1 w -� <br />. � ro <br />Uce Zone m ( � <br />ti � � <br />Fire 2onc ' } � �� <br />Occuoancy Grou� U � �� <br />� `� <br />Type of Construction � <br />� <br />. � <br />Occupant Load ¢ :•' <br />. p <br />Spr3nklers Required <br />• „ <br />� - 7'�3 - 5--, �--._ ; Gk.,. ur�,z w,U � ���_ G.S �,(,x V='~�--'� . .C� �' . •� o-�n^^�-x <br />'��.�Ml„ -cil�:,• �/.K�u-.w., �c.u, ,J.,,.y�- r?,.,�?..G� ��.�� .�..���f.W.-,�-[`i�- t�C1�7JCt.,,k �l /��.e�.�A <br />- �"� .�i.y t�i � ��.. ✓4-�inr.�5.�,.r��L� 3 S' ' f�'�`,� . <br />