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<br /> J1VY1��. ♦V VVY
<br /> . . a. c- � .G / 9 "rr. .r.�.� .,..., .u� �- . ,>
<br /> .. . ; f - 1z�{ �.�•c. _ ,�-���.. ��� v ��%'7 - �� � 7S �. • .
<br /> • � //I!� more than one buildinq 19 to be contruc[ed, submit a separate permit applica- •
<br /> . :! tlOp for each�huildinq. �1 ��eparate permit will be issued for eaeh building.
<br /> . �I��: Ovaer ���C�/.i' . ��` �c"�{ Huildin Address ' � ��C�; �
<br /> .L -� q //G l a rc-r�
<br /> , � � � �''- �/ ��� .
<br /> 3Edress ��:_z•�<<n•r 1% /�: ./ :�, Lot SIr_k
<br /> . City , /�v'<l< � Phone Snbdi4ision (Plat) ' • � '
<br /> ' - �rehitect/Engineer • . .
<br /> ': "� City • Phone Netes : Bounds (Unplatted)
<br /> - - 'i —
<br /> :�'. Coatractor --�Y4tS� � '__Li'_�� ..� � - Sec. Tvp. Rqe '
<br /> + �dICSS L_�J<'� C�L/�'t_c� /Z/':� �/.Clr'C I.�a7�t'�: l,�� _ZKJ��L ..- , �
<br /> ' - �T I .� •
<br /> �' City _<`• =K":t'� Phone,r��:� ���'.r� Building Gse , �
<br /> , ;,� ..
<br /> :� :,'•.
<br /> ;� , . . ^, i z`_`�'c- 3� . . •`-.• '
<br /> �i Stat:. LScense Nc�ber Describe Work to Be Done ,,�� ~ '
<br /> _y.��� d i�'L / - --r—
<br /> : . �! Er?ization DatB �9 .���,1 7 !s � -e �� � _ � .,,(� _ _ �
<br /> , . . . ,�� / . �.��= � 4' �c c :i < '�' c'�<
<br /> � I '
<br /> �� ' � ' . • SICETCH PLOT PLA!J HELOIP' • , c / "
<br /> � ; .
<br /> . � . .
<br /> : :� �/ ��� �� . � , � Ose oi IIuilding �
<br /> � ..�-.—/'� C .
<br /> a • . � � , . . . � ew ❑ Addition ❑ Repair/Remo:el
<br /> . . .: • . '• ' • ''
<br /> . � ; . ' - - --'�t. - . �— Valuation of Construction $ /J 7.�` - �
<br /> I
<br /> ,r.� '• � j-:- � ' . . • . � �`�� • - � PLOT PLAN REQUZ?2E>LVTS . -
<br /> ., . • • _ _.. - `lL' . . .
<br /> • ' � � • • � • ' I . �ti IAdicate lot siz�, nane of streets, '
<br /> � : :. ::� - . - . �_ -indicate locatioi, a:�d width o: _
<br /> • � alleys, locate oronosed ar.d all
<br /> �� ' :'� _ _ Yj : . � � existing buildi:gs, sho:+ distances
<br /> ^= � '�� to property lir.es, show distances
<br /> • ! � • � ' i � , . between buildings.
<br /> ' • — �� . , • _ ,
<br /> �
<br /> . , . Lot size �x � -- �
<br /> -" � ! . Eot area _ Sq. Ft.
<br /> .. • r.. - . . . ' � � � Size of Bldg. � --. Ft. �
<br /> `j �• � ••� � Numbcr of Stories
<br /> • ' �� • 1 . � • ' � I , Basement �
<br /> .:. ' ��i � .
<br /> �
<br /> '. ' � � Sigaed By �z'L%F✓ ��,� L,t �:c
<br /> ;- • I . � >
<br /> For 'll« G�T ;�� i.����c-��
<br /> ' -- ---- . ,.- . �� . , — Owner PhoAe
<br /> . ' DO :IOT S�:tITI: B2LOF7 3HIJ LI:IE-20R CITY USE Oi7L'! �
<br /> _ Date S�ceived q I S^� � o:.�e� zone . '
<br /> ' Plan C:�eek :7urber 7'J'��Zt7 ' Firc 2onc 3 '
<br /> � J 7 � .
<br /> Veluation �� `'� p�cunancy Croup _ (`
<br /> U
<br /> Pexnit Fee � �"��� G � 2ypc of Construction �- I�l . _
<br /> Plan Check Fcc 9 z ' Occupant Load .
<br /> � ibtal Fee Due � Z �' L � Sprinklcrs Required '
<br /> Date i55��a 1c . � c� r�' OF L-VER� II" .
<br /> c. 71 AFfRRO�,iCD.FGI� B�UfLDING PER�v1JT
<br /> �Tr��T ' ' o.;ie_�/3�_��v ►� r .
<br /> � o,.-� v�,��. _ - . . -
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