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' " • ' BOILDING PEtiHIT APPLICATION ! ./'" -7„ ..- �: `� .� , j' '-- <br />• . . • : ilpplicant To Complete This Sorm � /. � ' � ' •, ! ' <br />. /0�9��.� . <br />xltaore than one buildinq is to be contructed, submit a.eparate permit applica- <br />Cion for each buildinq. .1 separ�te permit will be issued for eaeh building. <br />' C�L-.vf��-{r�-� � ' . <br />Ovner �c,r ry G Yo� -{�u-,.. G e*, c% yP Building nddress _ib� S� �_=< �r Sc //o o-, <br />" y of L�,T .f L ru,- c i i� <br />1lEdress 3( a S �a � K 3'a %% e..� LoN :� /1�� :-%�,� Block �.5'�� <br />, City �✓nrt_ 1 f Phone �,S'`%•�/Sn 9 Subdi4ision (Plat) � • <br />` • Atchitect/Enginee= ' � ' <br />_ � s. : `._i City Phone <br />�;,•, Coatractor <br />'' �� ..' lddress 8421•17thAl.& <br />;.. <br />. '� City Phone 33d-.36..i.,7 <br />•� � . .. .,: . . , . <br />� �'�i � State,License Nu�er ,i�.�-���' ��7�3 <br />� • : 'i Ezpiration nat3 Fc,� . / %6 � <br />��' • SKETC}i PLOT PI.A?l B£LOW' • <br />. . � ' •• . <br />• / . 1 • .• • <br />. =� , � , ; . ' . . ' ".. <br />a• . . - ... <br />. .' . . ' � I . <br />'• • � , • - . <br />,,.,� � , � _ . _ .. _ - � . <br />+► ' ' '' � • <br />� . . . <br />. ± ' ' . <br />� �� . <br />. � � , • .. � <br />. :•� . <br />��. ..• • ' .-Y ' . <br />: <br />, ' �. ' 7. . <br />y <br />s . . <br />' ': <br />�• � • <br />1 <br />• • • <br />. • , .�'� ' . <br />y <br />Hetes L IIounds (Unplatted) ^ <br />Sec. 'lt+p. Rge � <br />:�� <br />Building Use ___ ' ._' `�Q_ _-. <br />Bescribe Work to He Dctie .�P_v '.,' � Y <br />�e .J , <br />o V M d'C / I a+� � . <br />Use of Building /7p s. <br />❑New ❑ luldition � Repair/Remo�cl <br />'Valuation oi construction S F oa. <br />i�IAT PI.AN REQUIRE.�L-'27TS . , = <br />. . �.S <br />' Yndicate lot size, nane of streets, <br />•3ndicate location and widt!� o� � <br />• alleys, locate arogosec and zll <br />• existing buildiays, sho�.a distances <br />to property lines, show distanee� <br />. hetween buildings. <br />iot size x • <br />. . Eot area � Sq. 1 t. <br />� � .Size of BlZg. Sa. Ft. <br />' Number of Staries <br />' Dasement <br />Signed By �.. I�o-�� <br />FOY / <br />� Owncr P.hone J y- � ,;J <br />' � DO :70T Sti:i?TLi L3=LOId TISIS LI:IE-?02 =ITY USz OiIL'I � <br />� <br />. _ Aate S�ceiced I •:� �=j (�1 � IIte 2one , <br />' Flan Chec;; ":ur..ber � ' ' Fire Zone ' <br />Valuation 4 � Occunancy Grou� _T_�� <br />Pemit Fce � ` -� � ' ��P� of Construction <br />Plan Check Fce -- � <br />� RbCal Pcc Duc �/y.�� <br />• J / r I� • <br />DSLC Y.^,.",LCCi lFif � / � 7 \ <br />. / <br />Occupant %osd <br />Sprinlcicrs Rcquircd _ <br />.. . . . . � . � . . . � <br />' � <br />G <br />