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<br />-- ;. ; , hpplicane To ✓�o;npleCc •rhis :>orm . , ' �,� 9�'�
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<br />..' xf isorc th�n anc Uuil.ding i� to bc contrur.tcd, svbmiC n ceparatc permit �pplica-
<br />� ,, i'ion for cach 6uildirq. A scp�r�tc permit will bc i::.ucd 1:or cacli bui].diny. .
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<br />, " � D�cr � { i �1 � G / ���� �.?C�R.��, � �, _::, llnildinq Address �,,.� ) � . j�l
<br />' � . Fadresa� � ; ��> � f ))',i)Y{;t.hi%�7.,_ Lot•_��� `I IIlock ��% . � , t ,�
<br />� � � City ��'�Q1,'� ;�t' Flione-� - - Sulxlivision (Plut) �_�i li i��'� ', n ��i i� •
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<br />'"'� City _ Phone � .bi�tes L ".ounds (UnplaCted) :
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<br />� � Contzactor i�( i r•,�, r, F i -�ji i � IC"4l'.},,� ,^.ec. � Twp• H9e _
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<br />'.. •' 133res.. 1�_�i^���.- ����1' ,�`�1��_ -.��� �_�Q �a.� . . . .
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<br />' -City �r � �� G(> !1 Ol�-{ Phone -')���� l t � � `IIui.ldinc� Use ,
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<br />� ' utate License iJc.:.ber �����i ��-' �-��'1-�� �� DescriUe 17ork to IIe Oone
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<br />. �. � '1 EzPiration Dat� �� % � � " I� Y� � �� � �'� � :�� rrp� '(' �� 1 V1 � �l� l : � �� �
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<br />. ��' " . , - SPSTCti PL'0Y PLA?i I3ELOi4� ' . . .
<br />- �� � IIr,e of.liuildir.g '
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<br />,. . ' - • " _ - � : � j.�lic;r ❑ Addition ��Repair/Remo::cl
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<br />• ^ • • • . ; , - [�aluation of Construction S , �>> fi';/ .
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<br />� � � • � .. . .� � :.PLOT PS.Tdi F.:QUI2L'�fE;:TS .
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<br />" •; , Indicate lot sizc, nane of strcet_^•,
<br />. � •' .� , ' = . . . . � � •indicatc location �r.c ::i-dth cf .
<br />. � ..I . . •- _ . .. ' . . � all.eys, �loc�tc aroposcd a :d a? 1
<br />, j.�� - • • • . . � _ � -c>:i:;ting buildings. sho:u �'i�;.�r.cc�
<br />,, ' ...-. - r .o . : �. � : � . . �Lc. property lines, .};o�� distancc::
<br />- ' �; - bett.�ccn buildings.
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<br />� � . � . � . .� � : . �7a'�t aizc _.
<br />' � .. � . Lot area � Sq. Fi;.
<br />� '�� � � : . � �Si�e of T+lr.g. Sn. Ft_
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<br />_ � �� . . � Hutabcr oi Sto+-ir_s
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<br />' - ' • ' � Oc�ner Pfionc r,;i' �,r i ��-' �
<br />� • � PO ::0: HZ?TS :S=LO!7 :'ItI� T,Itli.-POR Ci7'S' llS:i 0�1I.'L __._
<br />Datc �:ccived � _ U:.e� 7.one __....
<br />' Ylan C:uck ::u-:or • _ F'irc 2odc � —._.
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<br />" Occup:.�nc�• Group
<br />CaJuation 'r ; _ � ---,—_
<br />Pcs:�iY. I'cc � __ � _� �yPc of Con,truction _ _
<br />Pl:.n Chccl: 1'cc ___ Occupr,nC f.o�d _—
<br />, ,alal I'ec llue , _ ^psin?:lcr : R,�Ruired � , � __ .
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<br />D:.[r T:.::ucd ___----- -"' . . • ^ . . ,
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