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<br />, ' i � � ' . ' II�ILDItIC PL�'fIT 11PPLZCATION �, � � � ', �,••�. ' ° ��
<br />�' � ' , � , ilpplicant To Co�nplctc This :orm ' ' � ,�;
<br />.. i , '' j?�,5 .
<br />,-••� If narc than onc building is to bc conirvctcd, cubmit a.epara:c per:ait applic�-�
<br />.. tion for cacL builJ2n�. A separ�tc permit will bc issucd for each buildinq.
<br />.:
<br />�r� 'J �' ' G i%S /�
<br />. ' � Omer �i 7'� . i�-..�.; ./ ; ., _ Builuing Address / , �:i.� �,��, �r,V
<br />. l�ddress �/r9 � ;�9 0 � �� � _ , n /�' y " Lot � Hlack _,
<br />City �r.:� ; ` - Yhone � J �i"• Sub3ivision (Plat) ` � - / �
<br />�•
<br />� • Lrch3tect/Enqincer � ;�� .
<br />`'� City �one Hetes E Doun�s (Unplatted) '
<br />- . �i Contracto%;'1- f-1-�-*t ..
<br />:,' � z. �o-,/�r v^�1 Sec. � .,4.p. _ C Rg� v;
<br />, ' �_'.r',ress � . . .
<br />! -.City Phonc •Y3uilding Usc . ` '
<br />1 � � � ;�_,_-
<br />_ � .
<br />�'�i � Stzte Lic_nse Nc:.Ser Descrzbe Work to IIe Dane � ''
<br />: �1 }�Piratioa Datc C „� �, .� n l - �-- a^ �, , '� � .._ . .
<br />. -=-�----_-- ` •
<br />��' .. ' - SC.ETGi PLOP PL;�i BF.LOid' • ' "
<br />. � - . . �
<br />:.1 • ' . � . . Dse of Sui.ldir.g -- .
<br />_ � .. �. . .. . , : ' ❑1Secr � aldditS on [j�Repair/Res�c�_1
<br />' ' . _ . �' . ,p O .
<br />�
<br />� ��- _ �� • • . � • �aluat-icn o� Conct=ucCion $ ryj� -�� �
<br />. . . ' . . � � , . . .
<br />.. . . . . ` . , 1'lAT P7�1N R:QUI-:`i5LtiT5 _ .
<br />. , � � ' .. ' � ' � � ' Indicate lut ci.�e, na.:� c` strects,
<br />�� �' ' � - ' � � �indicate loca._o� ar.c ::icth o=
<br />' . ' � ' . _ � , �. . � alJ.eyc, 'leczte ro�osea �.-1 all �
<br />.. ' ;�_� � � . �. . . � . � ' .existing buildinas. shc�.a,:?ist�::r_a�
<br />. ..� � •�•-� " �''9 � ; . ' = ' . . -lo property :ines, sho:a dista:cesc
<br />. ' �..a � ' . - .. betxecn buildin,�. .
<br />� � - . , - + S.ot �ize x . ,
<br />... � • , Ir�t- arca Sq: rt.
<br />- . �� Sizc of E31dq. Sa. Pt,
<br />�•� , • • Hmnbcr o: Storics
<br />� �•! • 1. � � , . � 3;aser..ent /�
<br />,:. � . � . . . —
<br />•'/ r
<br />Signcd liy t,: :?.-;`> , .. , , r___
<br />_ , � ( .
<br />- For.� •
<br />. � . • Owncr Phonc � \ S_� /,��/
<br />e
<br />:70"_'
<br />, Date Seceived ` 7 ,�^
<br />' Plan C:icc:: ::u �Scr ' T
<br />��a:v���a� � ::5�9D �c..
<br />Fcnil Fcc � �j . Q�`�-
<br />Plan C8ec1: I'cc .
<br />�ota?. 2'cc Dur �i �- __
<br />... . �__ /. J -" —
<br />P3tC T::.^,uid � ��
<br />-FOft CZTY USr C:Ii.
<br />Uce�.^.one
<br />Firc ;onc
<br />Occuuancy Grou�
<br />T;�pc of Con;trucl:ion
<br />OccuP�nC I.ond •
<br />�Pr.inlcicrr P.cq�l.rad
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