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<br /> ^ • ( � ' , ' ' ' ' � 80ILDINC PEFiMIT APPLICATTON � , � � �-• ''Q�, �� .i,j
<br /> 2 : Applicant To Complete This :orm / � �� ,i
<br /> .. . � . . /��17��' .
<br /> , • ' If more than one building is to be contructed, submit a separate permit applica-
<br /> . , tion for each buildin�. A separate permit will bc issued Eor each building.
<br /> ' ' Owet �/''-Cl � ru � i�-l�C�r.�i/ 8uildiug Add=ess � , � , ,"v '
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<br /> b ' • , 3d3ress ;%S-C 7- : � ;� : ' Lot " Block %' '
<br /> � • ��', ,
<br /> , Clty C�v-c�r_�r Yhone_5'i S-3� � -/ Snbdi4ision (Plat) • ,
<br /> � . aichiGect/Enqineer . -� r�Z rt c{1 .^-, t',� � . • .
<br /> vEt'-2_�. -C'
<br /> � `,'L+ ; . _' City . Phor.e Metes 6 Dounds (Unplatted) ' _
<br /> :.� . • .
<br /> �;�•. Ccntractor;� ,��1!'c��,i-.�� � t��.�[�u � Sec. SWp. gge .
<br /> .; ...� . �� . _ . .
<br /> = '�, : �• ]lddress ��'�� �-.+ cLJ . . ,
<br /> _ • .'! City - �t��� Phone ' ' �- `i'- '- �' Huilding Use . . "•� _�'
<br /> -• h� � State License Nc�aber 2 I 3 � i= G ��%% Describe Work to Be Done `��`.~
<br /> !'� ' , . " . • .
<br /> �,
<br /> . : '� Pspiration Datp � R. ,�,�-� �•� �- -�'-:��-� 1-�L�-., -
<br /> � +.�' � • SICETCH PLOT PL.1*7 BELOW' • � � .
<br /> - `; j •.� •• • .,.� . ' , . ; � Dse of Buildirig ' •
<br /> ,! ,c �
<br /> � ���L.���4-L.. lC. ��>�L--r�ir/.�. � '
<br /> �. ; ., , _ _ . :`' , _, • �New ❑ addition ❑ Repair/Remo::el
<br /> . . . . . �,
<br /> � ''• �:� � H¢.��n� i .':������'-c�c.t',,- Valuation of Construction $ •
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<br /> •/.1 ... ,_:. _ I . - .
<br /> � ••,•�: .. - ' •..T�.�. :..••���•�. � �. . - � ' . . PIAT F'I.AN REQUI?2E}L:ITF . _ = .
<br /> - � '.�
<br /> • i . . ' • - • , • . • ' Indicate lot size, nane of streets,
<br /> ' + � - ' � � ' � ' ' �in3icate location and width of �
<br /> . � ;� I • - ' i'.: . '.; • alleys, locate pronosed ar.d all •
<br /> �, - �.:� , . � ' .� � � � , ' � ' CXisting bnildi.^.gs, sho:a dis.ances �
<br /> y . . ... � r- � . . , '-� . . to property lines, show distances
<br /> " : - • between buil2ings. �
<br /> i. � ' � '. .. . ' ' . ' '
<br /> . . ' • � . . . . • � Lot size x '
<br /> � � �� S.i- � . . . • ' ' • • . Lot area � Sq. Ft.
<br /> ' � , � � �: , , � . � . • � � . Sizc of Bldg. Sa. Ft. -
<br /> • ' •'i ', . ' ' Nwnber of Stories
<br /> . • . :: • � � . .. � � . . . .. . . Basement � .
<br /> z'r.. _ _ • . . . , , Signcd IIy •
<br /> �� . . . . . � � <; ?���-�-r=��
<br /> . '_ . � . . � ... For �
<br /> • - �� � • . O�ancr � . Phone
<br /> „' � DO :IOT t<3IT5 D_LOF7 T}iI5 LI:7E-POR CITY US O�IL'L '
<br /> . Datc �occived / �7 ��� II�c• zonc ��/ �l�CL .0 /%(JI�'7• /,c.' LC��
<br /> ' Plan Check L7ur.Ser —�— ' Firc 2one �� '
<br /> . Valuation ��� �� Occuoancy Group � �
<br /> Peroit Fee �7� � L� ' Type of Constrvction '
<br /> Plan Check Fce Occuoant Load •
<br /> —� } � . • .
<br /> , � Total Fee Duc ' l � � Sprinl:lers Required .
<br /> Daic Issucd ' l�' _ 7•5� . . � • . ' ,' . , • . .
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