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<br /> � • ( , " • ' ' 10ILDING PERMIT APPLICATION . d� ^ 4
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<br /> _ t : �pplieant To Complete This :orm / • •?
<br /> .. . ; • • //�/�s .
<br /> . • ` If nore than one buildinq is to be contructefl, submit a sepazate pecmit applica- •
<br /> � . , tlon for eacF building. �1 separate. permit will be issued for each buildinq.
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<br /> " ' Ovner '7 q D�r.Y;a'ia/- l•1U I-��i4 drJ Z/i�:. Dnildinq Addzess �i�, ir/ /;��6!'.1:�TnC�.a*e_� .
<br /> ' . : � teasess f h i`�' �c�e lr rr 'i�:^C r,ot /�' aixx 3��
<br /> • � ' «ty 1��� i l, Phoney�i��-7� �}L Snbdi4ision (Plat) �ll�')P�_� •
<br /> ' • �seIIite�` �Enqineer S,Jf✓�UL . � ' �T�' �� -- . .
<br /> • '. � '•'� Citp i • Phone ltetes t Sounds (Unplatted) •
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<br /> � :,'. Oontractor 1 �� �L'L1L� ��lt�(•I'a Sec. n+p. gy� .
<br /> ...� . . . .
<br /> ' : • . IidBress L'd-7�s/O/��C S (_. .
<br /> . .'i. City '�k''C.�? Phone �.�J"5 S�3 Huildinq Use f��i �S ---- ''^��,:^.,.
<br /> � .4� , ,. . . , ..�F..
<br /> .. ' � State,License Number /� �r� � �'i::CYC Describe work to Se Done ?1U�17�C�
<br /> � . '� L�cpiration Datt //- / J - 7� � �n,� r•`�71�'S i �S /�`n111Y2S
<br /> s,�' '� � • SICETCH PLOT PLAN B£LOW' ' , .
<br /> : :� . . . . , � Ose of Buildiciq ;�t�I, r"��• �
<br /> • . . ..• � •
<br /> ,, • • ' , ' . .,. �New ❑ Addition �Repair/Remo�el
<br /> _ � . i
<br /> ' ' ^• • • Valuation of Construction $ ��nn'� � ��
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<br /> •� . . . - � PLOT PLAN REQUZ_REhfE:7TS . : ? .
<br /> �,,,• , .. . . . . �.'+
<br /> ... . � . • �
<br /> � • y , . : � � ' Ipdicate lot size, name of streets,
<br /> •' ; " ' � •tadicate location and width of - �
<br /> ' ,� ' , jj . -. , _ '. _ , • alleys, locate proposed ar.d all -
<br /> , ;. � . , � lxisting buildings, sho�a distances
<br /> ' •;,, .•_. .. � • ' , , ��+s . . to property lines, show distances
<br /> ' } � • . . ' . . , _ - between buildings. .
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<br /> . � . 7.ot size X .
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<br /> ' ..i- � . . . . . Lot area Sq. Ft.
<br /> : Size of Bldq. Sq. £t.
<br /> �i r � ' . . Number of Stories
<br /> , :� ��' . ' , • Basement
<br /> r..�' '. �
<br /> + Signed By
<br /> � '_r . . . . . .
<br /> ' '• � � For —
<br /> ' ' . � ' � � Owner Phone
<br /> - • � � DO :IOT S�3IT� DELOC7 THIS LI:IE-POR CZTY DS� 027L'1 � �
<br /> • �' , � -, � � .�
<br /> Date Ceceived � Z�7 �C , IIce 2one �- �
<br /> ' Plan Check :7ur,.Ser ' Fire 2one '�� �
<br /> Yaluation JL-ZE n. � `'l Oceunancy Group V-�
<br /> Pemit Fce �� z � U 'lype of Construction ��.-
<br /> Plan Check Fee Occupant Load
<br /> a' �' rinklers Required N�� '
<br /> . � ibtal Fee Due 52 SP ,
<br /> Datc Issued /f 7 �7 n ' -- . • • . • ' � .
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