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BUZLDIhG PERMIT APPLICATION <br />Applicant To Camplete This _'orm <br />� � �r,_:� �� <br />�/�s� <br />:f more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. el separate permit will be issued for cach buildiny. <br />Owner �;. � /�' (!��n,>/,c/� Building Address ✓�✓r2 S. �-�'-'r .'i•'�-- <br />-� �?,�.licnO ,rP <br />Address j'C i-i� x 1'� Y�J iot_-�l-v F-'/v_ Block <br />.,�;.,i �! ��..� f.. , � .- <br />City ��.-,�.-fi� Phon� Subdivision (Plat) <br />Architect/Engineer /,,, � ; � "� r'i: : _i � :y 7 _ <br />City Phone <br />, <br />^_ontractor ��i-/n;.i -t��t:.r (•' <br />Address i���.� /Zsr�'Ji ,� na.,� <br />City _'��: r' : -' Phone �t/-�.-CU�,c' <br />State License ftumber �."L�j [iZ �`i�/�% <br />_� <br />Expiration Date � �- ' � '� 7 � <br />SKE:C❑ PLOT PLi+f7 BELOW <br />� y 5_ <br />,S r u� �� rt- a6 �� <br />� �x�sru�r� �enc�e _ �i;-^��. <br />� y� 'l�,' <br />' C� ''� `,: <br />/"�6 <br />���-r �! __��. �� -�„ <br />_ - ' � _'_ Ho�,La,/+�. A�e �o /—. <br />���= � / - S��C`- - � . <br />�-,_ __ ��` � / <br />Mctes s Bounds (Unplatted) _ <br />Sec. ,5' <br />Building Use <br />'ltvp.: Y �t� Rge _�.c" e:, ��1 <br />Describe Work to Se Done /-� >i��,.i.; c- �; <br />i � /.. <br />�'��.�n.-"rfv /„�.�- i;i _ ".=i�..- - <br />/�.� �:'i � /�";� /� . �,� <br />Use oi Building <br />�i.�New ❑ Addition ❑ Repair/Remodel <br />Valuation of Construction 5 5� Zz. �� <br />PLOT PLAti REQUZ?2EFfENTS <br />Indicatc lot size, name of str�ets, <br />indicatc location and width of <br />alleys, locate oropo=ed and all <br />existing buildinqs,.show distances <br />to property lines, show distances <br />between buildings. <br />Lot size x <br />Lot arca Sq. Ft. <br />� Size of Bldg. Sq. Ft. <br />Namber of Sto�ies <br />Sasenent _ <br />!� �% // � <br />Signed By �� ����(!-�•�°r2%�,,L�t��/ <br />Yor <br />Owner Phone <br />DO NOT W:ITC IIFLO[4 THIS 7,INE-FCR CITY USS OtILY <br />Date ^...ce'_ced � � �"' �� U�e ,'.orte <br />rlan C:�ec% ?lun:�cr �_ Fire Zone � <br />Valuation 3 6 ZZ . �� Occuoancy Grcup . <br />Pemit Fee ��� Type of Construction _ <br />Plan Chcc}: Fee � Occupant Load <br />c� <br />Total Fee Duc � Sprin}:lers Required <br />o�t� T5_���a / 6 ,S �- <br />n ^ <br />, .ti �.� . ����.�._ ,- �- rs <br />a <br />