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<br />� " • ' ' HUILDIfiG PESUtIT APPLZCAiION � � � �4 %'�• '" •j •�•)
<br />• ' . : Appliwnt Ta Complete This :orm / � �� �� .� :. • ."
<br />. . � ., �z/J��j,Y,
<br />2Ltwre ttian one building is to be contructed, submit a separate permit �pplica-
<br />tion for cach bui.lding. �1 separa[e permit will bc issucd £or cach building.
<br />' " Ovner � � , � . i ;' '' �. Huildinq Address ��� .
<br />• ,
<br />� , 7�Gdress . _ . Lot Blxk '
<br />• � �ty � Phone SubdiVision (Plat) •
<br />' • �sthitect/Enqincer • ' � ' � ��
<br />•�.� -'� City • Phone � Ketes G IIounds (Unplatted) ' •
<br />:.,' . �1 - , . -
<br />' ' • Rae
<br />:,• Cantractor �- f'`� f Sec. 'M+p•
<br />� � ' . . ,
<br />'- ' :. : `• �7dress
<br />- .• • �, �
<br />.. '1: �ty Phone Bnilding Use ",: -°;=' .
<br />. =:,�;..
<br />'`7 .: ,. . .
<br />-� "i State License Ni:r�ber Describe Work to Be�Done� ���
<br />Y .
<br />� • : � �pisation Dat� '
<br />��' '� . • SKETC}i PLOT PI.�7 BELOW' • ,
<br />_ ... : � • .. . .. , '. .
<br />Use of Duildirig
<br />t,.' `� • • ' ' ' _ �� •�tiew ❑Addition ❑Repair/Remo::el
<br />_ : c
<br />� - . � .; . � . . . . . , .
<br />., • , .� • Valuation of Construction $ � ' �
<br />. �� .. - . . � .. - . PIAT PLAN RLQJIRE.ES!':5 • . `
<br />�..�• . ' .� . . .., . , . � � . . �.:
<br />... . � � � . . � .
<br />. • .
<br />� , , �• . . • . '� . ' Indicate lot sizc, nane of s.reets,
<br />•� + � - � � ' � � ' •indicate lcca:ion and widt!� of -
<br />.� . . •
<br />' ,' ' 's . . •• ;:�: . '. • allcys, locate aroposcd ar.d all
<br />. ;.: ' � " " . � � existing buildiags, shaa d:stances
<br />i ,� " _ - y . `. ::'. ' . . t0 property lines, show distances
<br />..�, betWeen huildings.
<br />.. t � . � � Lot size ' . . • .
<br />, .� . �� i � � � . � . . � � . �. Lot arca ' Sq. Ft.
<br />:.i. . ,
<br />� � � - . Sizc of Bldg. Sa. Ft. �
<br />,.j ^• � ' ' . ' , Number of Stories
<br />. 1' ' - - � 8asement � �
<br />.. . � � � r � � �i
<br />•:. .
<br />� Signed By � •. , ,., �.
<br />'��,. . . , .
<br />- '• � . . . • � For
<br />' ' . . �' • Owncr Phone
<br />Date Seceived �n l' c )
<br />' Flan C:�ec;; :7ur..ber�� � �
<br />/� < <�
<br />Valuation � �,��-C�•
<br />. , r, �4 (;
<br />Pexnit Fee C-�% "
<br />• • .L�c.,
<br />Plan Check Fce �%
<br />� To[al Fcc ➢uc '-���� �
<br />Daic Tssucd �
<br />�' � . ... ' . . ' •
<br />'.i-20R CITY USE OtIL'L �
<br />IIcc• Zone �- � �.�/'/.�; � i= �>.��_ �C�F��
<br />d
<br />Fire Zonc � � �
<br />Occuoancy Grov� r
<br />Type of Construction `,i - N
<br />Occupant Load •
<br />SpzinY.lcrs 1�c�ut�¢d ["r�� iT �
<br />' q{�pROVEQ FOR RUIL'DII.G PE�—
<br />• . Y.. 2 ` __ Ciy � •' '---
<br />Diite ��: . . , .
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