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<br /> . ,
<br /> "' . . � HtlILDING PERMZT APPLICATION � - � -
<br /> . Appllcane To Camplete This sorm ' <' � ''''' 1
<br /> . ��''y � �� ;i;,
<br /> 2f more than one buildinq is to he contructed, submit a sepatate permit appli�/1 7 �'
<br /> • tion for each buildin3. .1 separate permit will be issued for each building.
<br /> ; � Ovner I��hF�J� SWi .,�;;iJ Gb��-i;. F �
<br /> . Buildinq Address S�9m E �
<br /> . , address �2 S' /n. � n
<br /> Y`(=L � lT---- �t Block . .
<br /> , : City ,� _, ,. r-! � J� phone ;�_' ?-(o�__q Subdivision (Plat) /(�, $d� „(-�ti,_ � .
<br /> c�51 s�3' .f �rn�,�t
<br /> _ • Architect/Enqineer S� �� ' I
<br /> :..i . !�. ����nl� H��t S�f� D � � � � .
<br /> City � �
<br /> - - . �-j ��-.�c..ff phone �- Ep�,y Metes L Dounds (Unplatted)
<br /> :, Contractor
<br /> _ � . —�n,nr- Sec. . ..
<br /> T+P• Rge
<br /> _ ' Eddress � -
<br /> ' City Phone i •
<br /> . �;i ----- �_ Buildinq Use _ (.�•,,,�, f�'� ::,, � . �
<br /> - State License Na�er � � '� � �
<br /> . . �i Aescribe Wo�k to e Lone �
<br /> � r �� 1� 10�� . ., �
<br /> ; i Expiration Dat� lL-ni1 $�°'� ---'L .
<br /> ' ISn� kof 11�;�s�-�-� �'zdc' S' 1' uf h� v Al :�1�S;d'r-
<br /> '�, , • SRETCH PLOT PLAN gEL0I4' •
<br /> , ' 1 . -
<br /> � . r�� '/1/�
<br /> . �-1 ` " �Y"I"��✓C�p �j(- �U�-r, - , Ose of Buildin4 ��1 o.�E � •
<br /> � �� .
<br /> -, QNew � Addition Q Repair/Remo::el
<br /> 1r �a` � ' • 'Valuation of Construction $ Up"�
<br /> � � : .
<br /> ,..... .
<br /> � � � . �• � N .� PLOT PI.AN REQUZ?2E?L:ITS
<br /> ' � � Indicate lot size, nane of streets, .
<br /> . ! • . �.. ' indicate location and width o�
<br /> _ , : .� ��i_.�— . �S� �• allcys, locate proposed a.^.� all _
<br /> ._ y existing buildi:gs, sho:a distances
<br /> to property lines, show�distances
<br /> � � � _ betWecn buildings.
<br /> ♦ /
<br /> ' ..: � Lot size �l a.` x .� 33
<br /> Lot area J R, lv� Sq. Ft.
<br /> � ; ��—�- � � Size of Dldg. - Sa. Ft.
<br /> �� Number of Stories
<br /> •�• __' I � �a Basement
<br /> � '' � �-- i Q �,(�
<br /> � ��� � �an�'j�� � Si9ned IIy _ ���vin�-�-�.c � i/VU'L'�Ui
<br /> - �� � �� For W��✓s.�n� 1 � � �,�.
<br /> t e /J
<br /> �— ner Phonc ���; �r.,uU•y
<br /> �VS
<br /> , DO :70T Si:iIT: �3c:;,OH Tf{Ig LINE-P07 CZTY USE 07L'!
<br /> Dace ?:�ccived �� /� �-�\ � ' �_ '
<br /> Uce Zone
<br /> ' Plan Chec;; :1ur„ber �5 � Z! 3 . • 3 ..
<br /> Fire Zone •
<br /> Valua:ion � �,����. �D �--
<br /> � . Uccunancy Group
<br /> Pemit' Fce 4-4 �— � —
<br /> . ---�_ Type of Construction
<br /> � Plan Check Fee ��. ;_ , r �,'� ticcupant Load
<br /> . ; Total Fee Due 1, 1r , �" • � � SprinY.lcrs Required
<br /> Datc Issued � • . '
<br /> ' • — . . �CI71� n�_ � �i�=r�_TT
<br /> ' API''17t1�,';`�, ; � y",-�t .
<br /> . . � Z �/O�� J � P! RMIT .
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