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<br />',- •, 1 •. _ , - . • • 1QILDING PERMZT APPLICATION . . �� , � � � v, 9 • �� ^ #
<br />t ipplicant To Complete This ?orm /�. �
<br />. 1 ' • �`� � c'�yc, �
<br />•, ,� If eore than one buildinq ia to be contrueted, su�mit a separate permit"applica-
<br />' .. : tlon for each bulldinq. l► separate permit will bc issued fo�r ea u,}� i )
<br />" � O�mes ' � '•,.�lnildinq Address 1�O��2k�lS f�IGY�
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<br />' . . �dds a �til�/ lJ!"ClcG���n,. ��t-w:� Lot /3 Elock '�O '
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<br />' C1ty z'Lt.c'iIr('.T phone,�S-S-.S"3/.(, 8ubdivision (Plat) ,�-, %.,_n��"i �
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<br />• ltrhltect/Enqineer �i%Li,�eir�„ 7� / • •
<br />, •.'�•�� . •.`•� 'City • Phone Metes i Bounds (Unplatted) ^ '
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<br />;.' Cwtractor ' Sec. iVp. ' Rqe
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<br />-: •.. �ddress • ` .
<br />_ • { CYty Phone Hnilding Ose ' ' '��'.ti:_:::�.
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<br />. ' � .M1.� �'1 � State, License Nmnber • � Deacribe Work to Be Dane � `' ~
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<br />. . ' t . L�iration DatB • -ac�,Q , LZ`G��, lGr�.�� . �D l%
<br />*.�' � • % SI�TTCH PLOT PLAN BELOW' • GlGii.�'-��Gi.� �
<br />.' .. r' ' � • � ..' ' C . � II��ilding {
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<br />♦ � ' . •. ; ' ' � • QNea ❑ 1lddition 0 Repaiz/Remociel
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<br />. " j � _ � • • - ' , ` � • "• • Valnation of Construction $ '�-' �� •
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<br />r�• .. . ,:.•' - � .• '. � FLOT PLAN RE4UIRF.l�fENTS , � .
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<br />- ','( • �• , • � �. . • � . • • ' Iadicate lot size, name of streets, �
<br />'�.' • - •I' ' • • ' + •3ndicate location and width of
<br />• •� .�� ' . : i:� ' . ' �t. ' illeys, locate pronosed and all �
<br />.. •: ��� . _ '' '� ' • - �' � existing buildings, show distances
<br />. . i ; ' .. ^+''' -c r-•�! ; . - .. h r . . to property lines, show distances
<br />: ! , + , . between buildings.
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<br />, . - , � - � • ' ' ' , . I.ot size x
<br />..i- � . • : " • Lot asea Sq. Ft.
<br />�; ': � .`. , 61ze of B g. �_ Sq. Ft.
<br />� i , , " , , '. lkYmber of Staues �
<br />:: � , : . , . 8asement
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<br />��': . . . Signed By
<br />• 1 ; . ' . . . . i' For .�J?S.� � n <<-,.e.c� � ��s•c.L�P/
<br />: . ' '. ' . .. . Owner Phone �`5-s--S-3/c_
<br />-' ' DO NOT h'RITE BELOI9 TH?i 71:IE-c^OR CZTY USz Oi7L'1 �.
<br />-• - Daie Seceived �J/3 0�"T S^ � Dce Zone .
<br />. . � , � . � 7 , . �
<br />' Plaa•CSec� :Jurber ' � Fire Zone '
<br />.alaation Occunancy Grou� ,
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<br />, Peznit Fee 2�` � Type of Construction '•
<br />. .' ' Flan Check Fee Occupant Load • '
<br />. � Sotal Fee Due 22 -,'���= b�rinklers Required � .
<br />' , . ' Date Issued ' �1 �0�7� . , ... ' , , � . . ' .
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