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•• •� . . . • DIIILOING PLRMIT APPLICATIOIJ ' ' �, . ti . � . ,T . _.
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<br />- ., , , , - '• 2lpplicant To CompleLc Thi� _orm , � /�,� / ,
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<br />,. •• If aore than onc 6uilclznq is to bc contructed, submit n.^.eparatc pci�mit applica—
<br />.: 4ion for cach buildinq. �1 sep�raCe permit will bc issued for each Luil.diug.
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<br />. � '6.mer�O,�'T a�(.UPi"Y� _ IIuilding Address %J�2C1�/�aq1bZ/,
<br />� . � ' aaar�s� �.3�n/ Ti��»�.�4/ .dUG' , Lot Dlock .
<br />' City �ve�"C//� � Fhone��! -�IG ^ulxlivision (Plat) �
<br />� • arc n�l,c'ecr G,a. rr'oSS sio� .
<br />• '� Cit�� �A� 'L 8S^ 3.fS,(— . .
<br />_ : :'=� y Phone FSetes S I3ounds (Unplatted) •
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<br />_ � . :,' Contzacto�.(J/q3 �eG'4' fi'��P !.T gec. ' ..
<br />. • ..' , � Ji'o N L+ o ���"T�.�-� �� ,�Pr �4e .
<br />� , %' ' 13dress �c� ry , � � � !Z
<br />�, -.City Phone Z-pZ2 U'Su3.lding IIse / is�' I�'�'[tSS/�1�• .��
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<br />�'�� ' State,Liconse t�i:r3br.r � 7-0/-19�0�o De�cribe S7ork to Be Dane 25i0.4�� �i�nry '
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<br />: �:. �i Ezpiratien Dat� J— Z. "j — T% � � � �DTO/� �LO �7"O,E'A�.E �4/T/d?(i �/
<br />= ` � � • * • ��si,�di Q�raX /Oow��T :
<br />. '� SP.ETCIi PDOT PL:..1 IIELOf4'
<br />: �:.� • ': • .. � I . . . � i/se of. Duildzr.4 /'isi 'l��oces5/h9 �
<br />�� ; •. . � 1\\�"� . �Hew Addition ❑ Repair/Remo::el
<br />• .i � � ' . ' .� 1(V'� \ ' �, ' . :' � . �s, ���, . .
<br />• �� ?' . � ' �\ �1.� • � ' . • - 4aluation o£ Censtruction $ YL ; �'w � "
<br />♦ . ' '� � � � -� • . � :
<br />.",,• . .. � �'.' . ^ :PLOT PLAN R:QUZ?tLts^NTS 2 � Li9b ,�T,�'
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<br />.•i ' ' ' ��./ ' � ' ' ' Indicate lot �izc, nane of. strectn, �
<br />' ' � ' '` ' �indicate location ar.d width oE
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<br />Datc Seccived �" f � - ,'�i�
<br />Pl�n C:icc;: :7ur.,be�. %5`.3"l.0 �'
<br />1�alnation � u? S3j � r�� °C
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<br />FcrniY.' Pcc '-i--� �� DG� � �
<br />flan Cl�eck 1•bo 3 d U
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<br />iofal r•cc Due `_c�S3
<br />Dz[e T��ucd
<br />a leys, locaec nroposea a;.d all
<br />exictiug buildir.gs, she:a di::t�nces
<br />• . -.f:o property lines, snow distances
<br />between.iiuiluings.
<br />I.ot size x •
<br />T.ot area Sq. Ft.
<br />Sixe oE Dldg. Sq. Ft.
<br />tiuiaUer of Storic�
<br />IIase:nen/�t-/�J�� �
<br />Signcd IIy`/' � 2
<br />ror 1�%'� � Gue�E ' •
<br />U:ancr Phone 2 � - ��_
<br />CI7'Y US2:
<br />Uce 7.one
<br />Fire 2oac
<br />O.cunancy Grong C:. _.�
<br />Ty��ic of ConstrucCion �,/- � - 4,�RJtit{�ry•��(�
<br />o�c�t�. ��t_ r.o�a
<br />T,pr.iiil:lcr� R��qui�pTN Q�E1LEf{��'T, • _' :
<br />. , , 'APPRQVED f-.QR;BUiLC1NG FERMIT •
<br />.. Date.�4:',%-r: By_L. C' •. .
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