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<br />aa.avut ��CCLlIt•dAVIV .'�._" .. i.��
<br />' •• � • : I�pllcant�To Completc This Sorm � '�'�y':• :.F
<br />.. . ; . • • . � � � -". . �O �• ;/�7 s'.
<br />• It more than one buildinq is to be contructed, submit u separate permit appliea- •
<br />� .. Lion for each building. A separate permit vill be issucd fot cach building.
<br />, � ' Orm�r ' �``N .'.'�- �jY .� L t �'S _ IIuildinq Address �i{S�' `� �� . `% r� .
<br />. � , dddress � S C � S �� f� /9G � Z�t IIlock '
<br />City L�E/���/� Phonc <>> % /)u�J Subdibision (Plat) __ •
<br />' • Arc6itect/Enqincer • � ' •
<br />_ `;� � ' � City • Phonc
<br />,�
<br />;�•. Contractor S�� � �
<br />., .
<br />� +, ' �' Mdres„ �
<br />'f City
<br />•:4i .
<br />�• � �'r� �� SWte.License Nu.�aber
<br />• .. �I Pzpiration DatB
<br />Hetes 6 IIounds (Unplatted) _ _
<br />Sc.c. 71,�p. Rge
<br />, '.�
<br />Phone Dnilding Use h!� ; �(' '�' ' ����:•d-.^'.
<br />Describ^ Work to Be Done- `..0 F�'
<br />� . ��i �:� � _�, �,: : �j ;'. ,<; �. : . /i'N _,, '. _
<br />� ,�1 : ' . SRETC}i PLOT P7.�7 BELON' W •� /�1'f �LJ v � �C,Ir,;', , ,y �- .� , ' � '
<br />� ` -..�� • - • ., . •
<br />.•' . •.. �- � . S � � IIse of Building � �'� � •
<br />a • ; . ' �('Pc� � ,� /.• f-i,�,r � . . '.. , �Nea ❑ tuidition P /
<br />• - . �.;" . ' -' �•.::t'.',.,';�Gn� i'
<br />L�Re ai.r Remo;Icl
<br />�' ' F� Valuation of Construction $�0 i 0 pt4 `
<br />� ��z. � m � .. . .. .
<br />,'• . .. :�ij��fo£.: ii� :
<br />1.,�, y� 9� �Yi.. PIAT PI.AN REQUZT2��L:1T5 -
<br />�. . �. . � ` Y ' i�Jr� ' •',
<br />� ' ' . - "S t .
<br />� • • � , • . Irdicate ]ot size, nar..e o: streets,
<br />.�
<br />_ . '�� ' . '+ ' •indicatc location anc wic:h o£ � �
<br />• � .�I - • " i:� - � : t�. • allcys, locate pronosed ar.d all
<br />� ��•�t � ' : - �- �� �t� ' c:cicting 5nildi :qs, sho:+ dis'.aaces
<br />. _• �.�( . ... -- `q �%�C�$'�`•a�. '�- it�v.- to property lines, show dis:ances
<br />� • � �•.•.- � � betxeen buildzn s.
<br />� ;.; .a. . r1�.P 4 . . :
<br />. : . � �{� �e:: - . .
<br />_ � .� ' . . Lot S�Z� X
<br />- . � � , � `�.n1JA� �_�r, : . arna � S Ft.
<br />: . . � I_� ' Lot 4
<br />• r.. - •
<br />�. �
<br />.r . :: : �- , -
<br />�
<br />• Size ot Bldg. � Sa. Ft.
<br />Number of Stories
<br />Basement __
<br />� ' . • �-4 � 7.r . f l ; (� . Signed IIy . � -
<br />. 1 _ . - — � ( -„ - -- For -. �; ��v� 2, r .�'`i"'_'—
<br />,' - - � . ' . OtlnCi � PhOne � r� 3 � �f - ,. %'.� %
<br />' . - , • : . ;n�,:��:.�.- as.�..�
<br />Date `:eceived
<br />S{:i
<br />I Cr'I 2_d..l-��-
<br />5 LI:7E-POR CSTY i75�-OiII.'L �
<br />Plan C:�ec;: ::ur..ber % � — 4-C-� Z� '
<br />Caluation ' C , E.�C��(`7•
<br />�L�
<br />Pemit I'ee _ ri?_ �`'' '
<br />. �L�
<br />�P�an Cl�eck Pce 'Z- 4�• ��
<br />7b[al Fec Duc . �J c��• ��U
<br />Datc issucd �� � r
<br />• .
<br />Dce Zonc
<br />Firc Zonc
<br />Occuoancy Groa2 �L
<br />Typc of Construction ,'\L. - I�-1
<br />OccupanC Load
<br />SprinY.lers Required �
<br />• � • ,.Clti1' ���:.eVf'l�1=TT
<br />' P,I;i �sD;i�D I��:ji':GUiLUIi,IG PGRMFT
<br />nr,,��_•a-of 3.�./�1�i;-1�' C '
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