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<br />_ � .. � . • ' ' � HOILDINC PERMIT APPLICATION . . - -- ;. -.!'j_.. .. ��
<br />„ , . , , � Applicant To Complete This i'orm ��CI�''��c/ �� � }. .
<br />%/-'-��%S';•
<br />� •` Z! more than one �uildinq is to be contructed, submit a separate permit applica-
<br />. .. t1oA for each buildin�. A separate permit will bc issucd Por cach building.
<br />• ; � Ovner ' f�/•ri� � (:�• �����L.F Duildinq Addiess � ���>> j�t�(�Y_'f f-CLc_t;�C_
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<br />, , • . 3ddress �:� . c'3—S �l:.c. Lot_ /i , i2 Blak ��� ;
<br />. City ���1%)2� St:'/LC�hone lri�/-ri%/`� Subdi�ision (Plat) c�%- -�Jz� �/ ,.
<br />_ � � kchitect/Enqineer • /J! U ��l%�� . . , ,
<br />�- � i . • ='i �tY • Phone Metes i Dounds (Unplatted) '
<br />;.. . . _ . � , ,�� '
<br />- :�'. Contractor _ -4' � ' Sec. Syp, gg�, , -
<br />. ;• : �• 1Sddzess ' _ _ , ' ' .
<br />• � atY Phone � ' / � _ '— : �
<br />�_i Duilding Use �cs'1Nr h'K'4'�;c— "". `
<br />. -5.'.
<br />: � r: ' . /) ::
<br />r State,License N�aber Describe Work to Be.Done �F'.'
<br />: . �i Ezpiration Dat� • _ �l'- KCC 1 (�'� /�J %G_ p-� �,�� ' .
<br />L�' � . • SICETCH PLOT PLAN B£LO[P' • -
<br />. J �; � - � ' . . . � .. • Ose of Buildisiq ' ' •
<br />�� i � ''�: �•=.•' , � •�New ❑]lddition Repair/Remo�el
<br />. . ; • �- _•;--'.--.- ._. • ' •.' • - - - - � �
<br />� �' �(�1,�-'C . . � • i • Valuation o£ Construction $ ���% �
<br />N'� . ��-.. _��,�•• ;. . �
<br />„ + - •� ,. ; -. � ^ � . PLOT PLAN REQUI?tE7tE:ITS . : � .
<br />� . , . � . . =�
<br />.• t .' ' � ' ��. '�• � ' • ' ' Zndicate lat size, nane of streets,
<br />• _• � : , ._•, : . .. � ' ' " 'indicate location anc? width of � .
<br />j ' ��,"�' ' '� • alleys, locate or000sea ar.d all
<br />_ , i�!1 . ..;^r,': �- \yr-.^ . .` � •' . ' �isting buildir.qs. sho:a distances
<br />� '' to property lines, show distances
<br />+..� ' �. � � _ 6etaeen buildings. .
<br />. . ' . . V . . . . . e
<br />• .. �: , . 7.ot size x '
<br />. . :.• -. .' , .
<br />• S•`- � . . , . Lot area ' Sq. Ft.
<br />. . �' r. '. • I ..�i � • ' • . Size of Sldg. Sa. Ft.
<br />� ' — --- �--• ' ' Number of Stories
<br />' � � ': • � � '7 � ^ " � ' basement
<br />, f •..� - a�C���GG-F�l���rZ _ _ _ • .
<br />� -'' � � • � . . � Signed By �L7 �.{�,.' �
<br />. �.: . • � ,• . • ' For --� y �
<br />. - . . Ownez Phone
<br />..' ' DO :IOT Si:iIT� ➢�:.Of4 T}iI5 LI:7E-F02 CITY USc OiJL'! ` -
<br />. _ Da[e S�ceived �� Z v "j � �� ' ti�e• Zone • '
<br />' P2an Chec:;.:7ur.ber ' ' Fire Zone • '
<br />Ces; .
<br />• Valuation % � �; Occuoancy Grou2 � .
<br />Peroit Fee ' C� . �=c:.�.. -
<br />Type of Construction •
<br />' •Plan Chcck Fee �� Occupant Load '
<br />' � c� —
<br />. Total Fee Due _�� — Sprinklcrs Required '
<br />/ �. � . . , .
<br />Date issucd t� "'7 �7 � • •
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