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<br />BUSLOING P£RNST TPPLICATIDN C% ,({�' �,6•''• ` •';f
<br />_ •• : 14pplicant To CompleLc This :orm f / U �v� ' � • "
<br />.. . ; . • • ' . �d�,;,`,z �/ f'. ' .
<br />, •• xP r,arc than one buitdinq is r.o bc contructed, sv6mit a separatc permit applica—
<br />., tioa for cacl� building. �l separatc petmit will hc issucd for cach buildinq.
<br />. ' ' Ovncr '�l1' �� � ( ��i:A�-i- iSuilding Address �j��! �� :�L'tc�� -
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<br />. � � � � �dd�053 . � �;I '���``ti�. LOt � j A� ; IiIOCk '��i � .
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<br />� , City, ( t'� �tio�-�_� Ph::nc7��—/'-�`%�� Subdi�ision (Plat) � I<,: r;�i � ' �
<br />, � ,.
<br />� ' • Iucllitect/Enginccr � ' ���1(��.1 �`i�l�., ' � '
<br />•'•�� "� City \• Phone � Iietes s IIounds (Unplatted) � �
<br />- - .�� '—E��REfi�SUiLDE .R�f�— . -
<br />:�'. Ca�•sa3�r7163 .{�.qgq_ Sec. Tvp. Rgc
<br />_ ...� . . .
<br />� , �ar��, Beos �c�+wAr � • -
<br />�1 CitY REM , Gnildin Usc . : '
<br />��_.__ 4 ;'o.- ^ ".
<br />�'�� SW:e.Licen�e Na�ber �� -G/-i/-�•%��' Describc Fork to IIe Oone ��`'Y
<br />. . - , _
<br />: .� �I izPiration Dat� ,�- �--�lln ' � t �:1� ti� e . � v � t', ��-,_,_;� � �
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<br />�� : . . ' . . � '
<br />� SKETCH PLOT PI1.1t II�LO?P � 7 �-t 1�-����.' 4 il 1 �� r� _ .
<br />' ' I . ' .
<br />: '.) " • � Dse of IIuilding
<br />�� ' ' . , __ ' . ' . � . ,,, � � � �ticw ❑ t�ddition ,�] Rcpair/Reno;.cl
<br />`. . . , . . :` ' �,
<br />. . .;
<br />' �• . " . • 9aluation of Construction $�`�QfP- �'
<br />.� • _ � ,
<br />-�.-. _ � " • . . „ _ - a � , , PUJT PLA27 RSQUI?2E.`L:7TS . , _ - .
<br />q ' .
<br />' ? • • ' • , ' Indicate ).ot size, nane of =eets,
<br />: .-,i � . .. .: . .' ' . ' � ' 'indica:c location ar.c wicth�oE ,
<br />. ��� � ,. _ xllcy�, lorate ^:onosed a:d all
<br />• �•' � � �ai�ting buildi.^.gs sho�.: dictances
<br />y � - ... � - r- �e � ; . ' . •~'- � • . go property lines, Ishow distanees
<br />t � • � ' _ - between buildings.
<br />: : : t , .• . . • _ Lot cize x
<br />.._- '
<br />• r.. .
<br />�.j
<br />. ' .• • ]•
<br />:.. - .
<br />a �
<br />, 3'� .
<br />• • '. Lot arca Sq. Pt.
<br />�� �. Size of Bldq. Sa. Pt.
<br />" � t7umbcr of Stories
<br />Dasenent
<br />� Signed'_-B� � � � _
<br />� 1 � � �.
<br />� For , � r � '� . , A � ,1� .�r�
<br />• Owncr Phone '��- �- ��l-.��
<br />..' � DO NOT Si:t?TE iJE:.0i7 TIiIs LI:dE-POR CITY USE Oi�L'! � �
<br />Datc �eceived Ucc Zone �_„
<br />' Plan C:icc�1,:u.:.bcr � _ Firc Zonc "
<br />Valuation ! .'�<ti( �(� �' " Occunancy Grou2 _^ _
<br />Pcivit Fcc � ' 4ype oE ConsLruction _
<br />Flan Chcck Fce Occup�nt Load . __
<br />' 'ibtal Pce Due _ Sprint;lcrs Required �
<br />. . . . . .
<br />Aate Is�ucd . . -
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