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<br /> __ ' ; ! ' . " ' � ' � DQILDINC PEtUtIT APPLICATION � , � � � • ' �
<br /> ,. •• ;-, :...I
<br /> 1 , , : Dlpplicant To Completc TI�i3 'orm ��� ��/:,;y��
<br /> , •• � TP core than one buildinq is to be contructed, submit a separate permit ❑pplica-%��,
<br /> . . tlon for each building. �1 ceparate permit Nill be i:;sucd Lor each 6uilding. � ,
<br /> . ' ' Qruer �� ' L�'. /7� . _ Suildinq Address � ' .
<br /> ' • � Mdress � :. �. . - / •� /
<br /> . . L�1.. �.. (;�,' 1/i,. . �� ._., .�'�� �4 �LOt ( � Elocx f- l �'�'� /.:.,t��;.,,:�
<br /> „ . , , .
<br /> , City ,�- �[� z;.7�7` Phone Subdibisiun (Plat) �
<br /> , ' ?sehitect/Engincer • • . .
<br /> •: � `'� City • Phone Nletes s IIounds (Unplatted)
<br /> _ ' - . 1 _,
<br /> : / :, _ , . ' -
<br /> . ..; . Contracto��L�.ol<;�-.. � ,��--�(:.:_� � Sec. Twp. Rge
<br /> . • � . '' lsddress �� ? ; �jS<(= � -- N',r' � ' •
<br /> �. . �t� City�i,�:t�r-c � '../'/ Phone(�Sy- (, �� �:� ' -Buildinq Usc ' � � • � '
<br /> � .i; . . . ' . :.;.: _�-.�
<br /> . � .: . .r G . ' . , . _F:�.
<br /> ';i SWte,License Nuaber_-�,- � _� /- /,r.�/., ::� Descrihe Work to Be Done
<br /> / �
<br /> • . �I Erpiration DdtZ� /. /7i �( �.� e �vt/�i i/. /�- �.c.>a�" j •. .
<br /> . /' � r
<br /> . . - - � `/ . � . :. ,, .
<br /> -� ' � • SKETC}i PLOT PI.�17 B£LOH' • r�-'-z.-c( �� : �r�..�.� �J��- , �i�"�rs-c �/" '
<br /> . � � -
<br /> _ .•J. .+ . � . " .� .
<br /> : :{ ' • , • Acc of Building
<br /> �' � � . � � . ... ' �New ❑ i�ddition ❑ Repair/Reno�el
<br /> . . . �.;� . . • �-�c:
<br /> ,� _ " . - � 'Valnation oi Construction $�'._'�:_'
<br /> '. . . _. � .
<br /> +�-- . •' ' � .-,• .:. �' .. � . PIAT PI.1N REQUIRGSL:ITS . .
<br /> � . . .._ � . . .
<br /> � � . , . . . . . � '
<br /> ;. ; • • ' ' ' . • • ' Indi.caee lot size, nane o: streets, �
<br /> � . .'{ ' • . : ' , • ' •indi.c�tc location an� w?Z:h of �
<br /> • . �� • � .. _ aZlcys, locate proposed a.^.d all
<br /> - ' .'� . . ... • - . , • . , • .. . � er.isting buildings shc:o distances �
<br /> - '! . I°- 4o yroperty :ines, Ishow distanees
<br /> ; � • � � ' - betwecn buildings. .
<br /> . ' -' ' .
<br /> - . , I.ot size x
<br /> . . • • • �
<br /> � : .•. . � � � . . � . . . - , , � '. Lot arca ' Sq. Ft.
<br /> . r, - . . ,. � � � . Sizc of Hldg. Sa. Ft. �
<br /> � � '�j � - � • � - ' ' Nur.il�er o£ Stories
<br /> . • . :: . j ' . . . . . . . . • Dasement � � -
<br /> •:- _ � . . � � � � . � . � - .
<br /> .
<br /> '� � � ' � Sig�ed �y " " ` � � �J .• �r .%"%�C' -[ � �/r/ �
<br /> �: , , . . , .�_ C,` : _.
<br /> . '_ . ' . Por� ,Gc 1G..z, ., / _C—t �. .
<br /> .' - . .. . _ ' Owner Phone � / -� _ (- 7 �- S, .
<br /> .. ' . DO :IOT SCZ?TL' 9=L0['7 THIJ LI:1Fr20R CITY USE Oi7L'l ' .
<br /> Date r:ceived Use �one .
<br /> ' Plan C:ieck :7ur,Ser ' ' Fire 2onc '
<br /> Valuation Accuoancy Croup
<br /> Pemit Pcc Typc of Coiutruction
<br /> � Flan Check Fcc - � Occup�nt Load • _
<br /> . � Rbtal Fee Due Sprinl:lcra Required � .
<br /> Datc Icsucd . ' • . . , .
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