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_' • .• t • . . llpplicant To CompleteyThis :orm /99�•� �.Y�
<br />H , i . . : / . . ...
<br />' Yf more than one buildinq ie to be contructed, submit a separate perniit applica-
<br />��►.•: tion for each buildin3. .1 separate permit will b� issued for each building.��/��o
<br />oJ
<br />. .• Ovner �ATHCR� I`1� f�a ��,U. , 8uildinq Address �.� S i') %�l � nOL'(,lall_:
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<br />� ' • � iddress 3'�.i�� �� �nU�/��.� , Lot � 1- 1�/ Block �]�%'C�
<br />• �� �.�'L{�� Tr Fhone c�'.�i�- 5/3.; Snbdi4lsion (Plat) C.VeJZC n�,a r.).n _-
<br />•' , S�
<br />' • Azehitect/Engineer 7���'.-, ���"';�� �. • � rr �• � /a I}'Li . ..
<br />• r, � ^•� City ( r- � . r r• Phone ��'� ' - Hetes L IIounds (Unplatted) � • '
<br />i ' Caatr.actor l�% �` �^ �' �. � J' Sec. 'n+P• Rge .-
<br />:." . .
<br />- �, • , . . . .
<br />- :, •'- Mdzess � � ; � 9 ' / i-
<br />_ • . , Y City �i/ > �.. i r ;,/ �' Yhonc �S � ,> r� � . guilding Use � � r�� ' ' ': =� i..
<br />, . - .. .:�.Y ..
<br />�` �� Sta.e License Nu�ber r-�3 D 1- i�'� 5'i � Describe Work to He Done � i` F
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<br />. ..,��'� Ezpiration Da:B ����/�C. ' '�"�lil: �i1Jh�i�Gl,
<br />i,�: � � • SICETCH PLOT PL.1I BELOTQ' • .
<br />' r • ' •• ' � IIse of IIuildisiq
<br />�o��� �4 � .. .. .. .
<br />' . i`'1. l7c,s�e:�i��. � ' •
<br />�, . , .,. • [�tiew ❑ ��ition � Repair/Remo::el
<br />• • •! ___ ___ � . _ _ .,�— . • �{►aluation of Constzuction $ 2���0/�;��
<br />�!s �-� J ' I . BIAT PLAN REQUI?t��IE:7TS �.
<br />�- �. . � � � •\ . . • . . � ti {
<br />�=�� '
<br />_ . .
<br />i„ �• Ipdicate lot size, nane of streets,
<br />• y. - •' in8ic�te locaticn ar.� width of
<br />" �' -" j•� alleys, locate proposed ar.d all
<br />. , � - " t: � - .. _ ' ' ijj. �:
<br />_ ,. � : ' : �•�'3� � �7.. existing bnildiags, shc:+ dis:ances
<br />- i',� '_ ..,. --. ,� t.o pr.opertp lines, show distances
<br />_ ���' betveen buildings.
<br />. �' i ' .. . � � � .
<br />. • bot size _,7�x /Z �
<br />.�' � ' ; , . . �.:. � '. Lot azea ��'DO Sq. Ft.
<br />_ � � �:.i c • � � �_^�' ' . .
<br />. �. -: _ Sizc oE Blcg. �7 JJO 5a. Ft.
<br />r. ' %S • �: � g�er of Stories _,L
<br />. �.i . :
<br />, _� 1• . . , . ' : , Hasemen �
<br />, r:�-- , , - Signed B J.c. -
<br />• ,. � . �
<br />'� ' QC.C�.Y.. � . • • Fo.r �i 7/�C-� �'Ifl• l�'� �5�- S/�3
<br />• - ' ' •'. pwncr Phone
<br />� . � DO y0T Si32TE HELOFI THIS L:��£-POR CZTY US O2tL'! �
<br />Date `:eceived _ Uce� Zone .
<br />' Plan C;�ec� t7ur.ber
<br />. i 7 G. c'p c.-� -�
<br />Yaluation
<br />Pcznit Pee % � , �, �
<br />Plan Check Fee `7.- a
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<br />, Ibtal Pee Dce �
<br />Dacc ]:ssucd
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<br />N
<br />Q
<br />Firc 2o:ic
<br />�t -
<br />Occuoancy Groa�
<br />Type oE Construction � iS'
<br />Occup�nt Load —
<br />SprinY,lcrs Requ�red �
<br />. • ',EITY.QF.�JERETT
<br />..: AP��OV[D.��R�f3U1LDifJG P�RMIT
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