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<br />" ' , . S , � .. . � • SOILDING PEAHIT APPLICATION , X C� _l'%/ J(.' '. : j
<br />- ' , , � � �pplicant To Complete This :orm / �' ��•.� +
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<br />,.••� Ii more than one buildin is to he contructed, scbmit a se arate /�,•� �
<br />4 p permit appl ca / S
<br />.. tion for each buildin�. �1 separate permit will be issued for each building.
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<br />. "� Orner y��� ��.�-�-. �,, �•� �"� � n�y�r�r;�, &ui2ding Addzess c1 h l�i S a..r� 3 �.Q .: .
<br />. � � . :ddtese '/ h / L/ i�-� „ r7'; ,4 �.+� Lot �-�.� /� IIlxk C� O � i�n n �iE�
<br />C1ty �-`',�_�.t._!'� Phone ��u. aopu Subdi�ision (Plat) �Z.� y,S�� �7R -
<br />, ' • lredl.tect/F.ngineer • .
<br />•:+ "� City PToae Hetes t Bounds (Unplatted)
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<br />' ;,' Ccmtractor (�),1:��. ,����Ca ��..��(� .'�� Sec. nvp, Rge '
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<br />_ �..� I�9ress �Sa9 i.i4-.�,�+ (�.1�. ' • • ,
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<br />'t: City �, � , �'�', Phone .3,5,3 - �i �l �� ;� Building Use ��14 , f, �, , ,_c�' • �
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<br />�� � �i � State. License Nw�ber .� a3.o I. 18s33 Descrihe Work to Be �Done %�-.�,.lQ.. ���� �'�,-
<br />_ . ..':I ?sPiration Dat� ���� %% � �v,�-.Cr , .d�c-l-;-. �.-...-,,. � .
<br />i ,
<br />�� ' ' � • � SKETCH PLOT PLA?7 BELOi�' • -
<br />-. .! . . . ' . • . .� Ose of Buildirtq '
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<br />�� .. � . , . , . �New ❑ Ad3ition I� Repair/Remo:7e1
<br />. . ,;' .. • . .
<br />. � : � � . . i • Valuation of Construction $ p } , p �'
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<br />^r-- � " ✓ 1' . . . .. � � ' -� ' � PLOT PLAN REQUI?2E.+SENTS . " -
<br />y . . . • . . . ..
<br />,! `�""�� !�h' • e Ipdicate lot size, nr.me of streets, ;
<br />�� '- � ' ' 'indicate loca:ion and width of
<br />• • j "' ' �� .�-�-:��=�'� : - alleys, locate proocsed a.^.d all ' .
<br />' `'� � existing buildings, sho:+ dis:ances
<br />. ,� t � ��°� �-'� ' "'� � ; . • ' . �~=• � . . to property lines, shuw distances �
<br />, t ; ' � ' , - betv<en buildings.
<br />, _. ' � - .
<br />� —� � Lot size x
<br />• ... �--- . .7at area Sq. Ft.
<br />�; r. - � : <
<br />' • ': -� . •
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<br />Ddte SeceiVed � �'�' / p' ""j � -�
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<br />' Plan Check _Iur.Ser ' �
<br />l`) G"
<br />Valuatian `=';��.�'�
<br />Pemit k ee �_, C� . L'�-''
<br />Plan Check Fee
<br />� 1bta1 Fee Due � � `
<br />i ,_
<br />. DaGc Issucd ' �� �IiD F !�.
<br />Size o_ IIldg. Sa. Ft.
<br />Number of Stories
<br />Basement —
<br />Signed Sy ��l `, �JaC=.1.
<br />For CU o;2.,�� . �4�S�c I�J_.� � Q.1�'-� �•-e
<br />Owner Phone : ,S",q_ 6 �! a �
<br />CITY US'n OI7L'1
<br />Dce 2one
<br />Firc Zane
<br />Occunancy Grou� _
<br />Typc of Construction
<br />Occupant Load .
<br />Sprinklers Required
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