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<br />• � I � � ' � DDILDING PERMZT APPLICATION � // �� �� •. ^�{ �
<br />'- . � Applicant To Complete This ?orm /g � �'
<br />. , �i� 's ,
<br />•' If more than one building is to be contructed, submit a separate permit applic�-
<br />., tlon for each buildinq. .1 separate permit will be issued for each building.
<br />� : � i. � ��_ /. - ��;1 - ...
<br />•'�eL j, ,- �) , ij,'/-. ,L i(�:-� � v Huildinq Address
<br />� � �� � �, h�.:/�: �
<br />' 1lddress � / ;'C7 l - � \, �z -t" C+�L C_ Lot�'i'�/�r,�,i '! % Block _; � .
<br />� City C �-�+_�, Phone �� 5 � � � 7�'�`J S�ivision (Plat) .� - �� %�i�� ��'
<br />' • Architect/Engineer --�
<br />`'� City —. Phone Metes i Sounds (Unplatted)
<br />� � f Contractor �r '.�, �f "�. . �%.v' /-.�., � .�,��. Sec. 1t+p. � gye .
<br />' :' � i . . . • .
<br />c . , l�ddress ��/ /� � � ( t } �)
<br />• - �
<br />.. � !� City < y , �t1 �...c�� �i 7hone � : � 7 / Building IIse � � " � � : :+'..
<br />�� J'� � SWte License Nur�ber Describe Work to Be Done �'� �.
<br />�i .
<br />, . . • i- (' ' .�' , �, L, ��C_2�_/
<br />. .�,� Ezpiration DatE
<br />� • ' ` n� •� � /� � /�'1� �_ _
<br />��� �� � SlCETCH PLOT PLAN BELOW' ' , . .
<br />"' �� � Ose of Buildiny /
<br />. �.3 /.(�.'' . . �
<br />1
<br />� � , ,. ONeu ❑ Addition Q kepair/Renouel
<br />. . .. . � ,�,_o :
<br />• , • ' ', ' , j(; Valuation of Construction S�iv _
<br />• ' " • ' P7AT PId+N REQUZ?2&`tENTS ��. `� �-���i i, � , . �
<br />�. , �
<br />= .
<br />. � , . : • � �• � � � Indicate :.ot size, nane of streets,
<br />�indicate .location anc wi�ith of
<br />, . � �i� '• . ,-��� � � alleys, locate pronosed -.nd all � -
<br />. ,,.� - . . - . existing buildir.gs, show distances
<br />.. y -q���• to property lines, show distances
<br />� - ; , . • . betaecn buildings.
<br />� • � . • Lot size X
<br />' ` � � . Lot area Sq. Ft.
<br />"�. �"� m"— �� " � Size of Bldg. Sq. Ft.
<br />' r• ' /�/ I Number of Stories �
<br />� ; .. d.s�
<br />. ' ..! . i / ( • �. � Basement _ ^
<br />C:
<br />� I/ ,r
<br />" -- � Signed Hy �%�� �i�f.:.�°' .__Y�!!�
<br />.�,
<br />- � �. J
<br />� ' . ' Fos--� _ . i.( -L,q .-�.c._.� �
<br />� � �� �?c'/-'�t� %��: �� � Owner � e one ���C ,�-�
<br />DO :70': SiZITB DFLOI'7 THZS LI:dE-FOR CZTY USE 07iLY
<br />- Datc Seccived �" • -'' 1 Uce Zon� _
<br />' P1an�Check :7ur..ber � Fire 'Lonc �
<br />Valuati.on �� - Occuoancy Group
<br />Pemit Fee �� Type of Construction
<br />�� Plan Check Fee ��� - Occup�nt Load
<br />Total Fee Due �� � Sprinklers Required
<br />. .. . Datc Issued � � - '' � • . � � .
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