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, .., i <br />pyyyYyl\V CLMIlI /�L'a'LLI.M'1'1VIV � , / <br />-- •. �pplicant To Complete This sorm C� 6'��� <br />' If aore than one buildinq ia to be contructed, submit a separaee permit applica�/��y <br />� LSOn !or each buildinq. A sepazate p-rmit will bc issued for each building. <br />"•' pmer �n�U<<� �K��" ��/ �+�'�� _ Huildinq Address � ' <br />� ',aer�gs 5 r�-�' ,S'. X Kd r.oe� sio�x I�_ � <br />� � �� �� ��` Subdivision (Plat) � <br />. Clty �✓(c. Cf' Phone .Z 5'd` 1iG f / ..._— <br />, � ��C1_) �J O � l.�C� cUt = �. __ ' <br />- �rehitect/Enqineer <br />`"� City Phone Metes i Bounds (Unplatted) _: <br />- - 1 gqe <br />� Coptractor � Sec. �'P• — <br />� . • <br />` 7ddress • � <br />; �ty Phone Buildin3 Use _ �;.�-�.._ <br />�.; •�' Describe Work to Be Oone N.S _'� <br />.. �� State.License Number : , <br />� � � �. �i Lspization Dat� � � (y.� � S�'�.oL.� Ct e (� '— . . <br />�1 : �" � � SICETCFi PLOT PLAN BELOT4 � • / , . <br />- ;• i . Dse of Building C�G� l� ��— . <br />. : �1 ' .- • . . . QNew ❑ Addition ,$1 Repair/Remo6.e1 � <br />�. ' . . . - .. ,. �. . <br />. . ,, . � � � . _ . Yaluation of Construction S �n-� � � .• <br />� , � . ' � . ' � . PLOT YLAf1 REQUI?tESfENTS - . <br />�. <br />: <br />' <br />@ <br />� I indicate lot size, name of streets, <br />� � �indicate location and width of <br />� alleys, locate nr000sed and all <br />lxisting buildinqs, sho�,� distances <br />,:� �. t.o property lines, show distances <br />� _ between buildings. , <br />' Lot size x <br />I,ot azea Sq. Ft. <br />' 5ize of Bldg. �_ 54• Ft. � <br />Number of Stories <br />gasement _ <br />Signed By � �� *'��� � � <br />� Poz �c�c �( C'l ��^ r 4 Li ( <br />Owner Phone f�— <br />B=LOFI THIS <br />Date ^eceived �{ � ' — <br />.-�-- <br />• Plan Check :7ur.,ber � <br />Valuatzun ��L��� � <br />pemit FPe <br />�_ C� CJ <br />PLan Check Ece <br />� �-�c=� <br />1bW1 Fee Due _ <br />' Date Issued � �I ��' � S� . <br />� <br />Oi7L <br />D-e Zone - - <br />Fize 2one 3 ' <br />Occuoancy Grou� � Z — <br />Type of Constzuction _ v- i--1 - _-- <br />Occupant Load <br />:Sprinklcrs Required <br />� CITY OF EV.=RE�T � <br />APPROVCD FOR' BUILDING PERMIT <br />D�te `t�-�%��By �—.v— � —_ <br />,; � .-.: - Y `:> <br />