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' ; � � � SOILDING PEAMIT APPLICATION � � � '� � • <br /> �� �� . ' � }lpplicant To Com-,�lete This Sorm �% �-�j� <br /> , � • Zf more than one buildinq is to be contructe3, s�bmit a separate permit applica- � <br /> . . tSor. for each building. A separate permit will be issued £or each 6uilding. <br /> G ,t � ' t � - j-' , , / � /r . <br /> . ' � Owner L l- =l� `-/:(r,'� i, Huildinq Address r -i�� �`,° �� "-.i' : <br /> , llddress J;(,� .t TC//�F �E:�" Lot % 1� ' -' Block � . <br /> ' / , <br /> City i� ;.�' ' '� % Phone 3 55�(•c SC• Subdivision (Plat) • <br /> ' � Architect En Lneer <br /> / 4� C° °�:'(=�7T . � �.�,, - 4��rK� _'n�� <br /> '"� City i%r,;�i�%��i' Phone 'S %-� (-<'%4- Metes 5 Bounds (Unplatted) � � <br /> - - �f <br /> . � :, Contractor ''ir.!•,' � Sec. '14+p. Age � <br /> ` I�ddress . • <br /> - - � <br /> ' City Phone Buildinq Use ;:."' '�i� d- `�%(Y-'�-'c>�•`�' , <br /> - ���� � State.License Ncraber Describe Work to Be Done ��'� �� <br /> � � �I Expiration Datz � � � <br /> :� ' � � � SRETCH PLOT PLA`7 BELOIJ' • <br /> . ' j � Dse of Building � <br /> { . . . <br /> �� ` r Yi��'���. 3 ��5/n,;5 • � L7New ❑ Addition �Repair/Remo6cl <br /> � " ; � . ? �`� �" Valuation of Construction $ `//QL� <br /> ^....• � , •�-` �i2GY� t-i�m� _� . . PIAT PL.AN REQUIRE}L:1TS . <br /> . G��r,,;{;,> ^.�ay . • - <br /> ' ' � . '�`�=• A' �eio:. It7dicate lot sizc, name of streets, <br /> . ' ' � k' `""`^ �indicate location and width o: <br /> � . � �� • • `-� � - allcys, locate nr000sed a,^.d all - <br /> . � ?'.� ;� � � ~ `� exi�ting buildi:gs, sho�d dis�ances <br /> � r:�,v`: <br /> � •- •! , , ' tu prooerty lines, show distances <br /> � � r� � � �,iy� ' /�p��y:- betaeen buildings. <br /> j. . -� . . <br /> � . � i7a��u � Lot size ��,, xJ(�;7_ <br /> - `J i . - —� . Lot area �j ��' <br /> ..: \ �;•�('1.. Sq. Ft. <br /> . � �.. g . � Size of Sldy.0 /:�� S;�- Sq. Ft. <br /> ' : Numbcr of Stories I <br /> � <br /> . � � �.: . j � / �� � ^ Basement _--- <br /> .:. M <br /> . ''• � � � __� Signed By � <br /> � . For <br /> � /,1 l Qwncr Phone <br /> 7L< I_`l.� L '. <br /> .� ➢O \OP S�:2ZTr BELOG THIS LI:IE-cOic CITY JSE OtIL'1 <br /> Da[e Seceived (p/L`f-�-''—_ Uce� Zonr .. <br /> J- <br /> ' Plan Check ::u.:.Scr 7S'�(�/ ' Fire 2onc ' <br /> �/ G <br /> Valuation y+l�• � Occunancy Grou� <br /> Pemit Fee �� � �'— Typc of Construction <br /> Plan Check Fce ��P -� Occupant Load <br /> p U <br /> , Total Fee Due �C� � Sp=inlclers Required <br /> Datc Issucd _� � � . : , . � <br />