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<br /> �� ' " • ' ' - �UZL02lIC PESt1�tIT TPPLICATION � . ,� ;' �;"•, •°;j
<br /> ;" • � . . � Rpplicant To Completc This :orm • ,.�
<br /> • Tttnorc than onc buildinq is to bc contr.ucted, su6mit a .eparatc permit applica-
<br /> � . , tion for each buildin3. .1 separ�ce permiL will be issued for eacli building.
<br /> . � � � � �� . , .
<br /> , � ' Ov¢cr �ii�,: r� E•r.i:�� uc•� - , Buildinq Addres� .�r/ � '- �a�.• /r'.,.:.:-
<br /> " ,.�
<br /> " � . .���•-'r��_
<br /> ` � /r'. �i%: ( :/r i' Lot Block
<br /> • , Eddress
<br /> , • � City ;�.wr-.rJ Phancis `� �� �' �' Subdi4ision (Plat) •
<br /> �
<br /> � ' • Arehitcct/Cnqineer • ' � ��' /''� /����� � _ ��
<br /> _ !;` � `'� City Fhone Metes 8 Sounds (Unplatted) _
<br /> �1 .
<br /> :�'. f.ontractor ' ' Sec._ 7tap. Rge
<br /> _ ...� . ,
<br /> ... • r' Addre�s �i�o�i«. �.,_c- �z,.-<.�.�,�. � . . • , .
<br /> „ 't: City Phone Huilding Use .,�/ .,u' ��= '=+"d'=��..
<br /> ' ,41 — , '-<,.;r:.,..
<br /> � £tate License Na�ber 'r.%�J - ��� �-i����%( ��cribe Work to 9e Done�� � '
<br /> � • . �1 EiPiration Data �l _ � � �. ���.��'`�/' '/ �` ..,--� ,
<br /> �
<br /> �� � ' . • SfiETCIi PLOT PI.A?I IIELO!J� ' - �
<br /> - ': ', -� . • . . . . . . � Use of Duilding �
<br /> �, � • ' ' . , , �itew ❑ Addition ❑ Repair/Remo�cl
<br /> _ ' . , :
<br /> ' ' •'• • � . • Valuation of Constrv� tion $ '
<br /> � !� " .. . .. . ' . j , . - �
<br /> � •� . . � . . • � .. . - . PIAT PLAN REQUZR��tE:7T5 . , . -
<br /> ..,.- . - : •�. .-.. - , .. � . . .
<br /> r � o .
<br /> � ' � ' '
<br /> - i , , • . . • • • . � 2•. dic:�te let si2c, nane of �reets,
<br /> •� �; . . � ' • ` •indicate location and wicth'of -
<br /> " ,� ' .' � • . •- ;°: _ '.; , • ulleys, locate p:ocosed an� all •
<br /> , ;.� ' • - ' � . ' � - ' existing buildi.^.g=, shc:a distanccs
<br /> � ��,� - • � _ - . - -- y . : . ' . •�'i� ' • . to property lines, show distanees
<br /> � . . ; . � • - , between buildings. •
<br /> .. i. + _. . . � ,
<br /> , _ . _ �
<br /> . . . , . _ , yot size%a S �
<br /> ! � s . . ' . • . Lot arca Sq. Ft. �
<br /> � .•� . � . ._ � ' ' . . Sizc of Bldg. i %i < Sa. Ft.
<br /> � � i�i r' � � � �� . ' � . ' ' Nu:ak7cr of Stories �i_� ��
<br /> . • :_ , i' ' . . . . . � IIasenent �.-,-�,= --
<br /> �i:. � . . - '� � %�� � '
<br /> ,' _ ..�-- Signed By i '��—>` � � . ,'
<br /> � '
<br /> ;. , ' ' • � � -
<br /> • � . � � For /i_�' '.� ; � �� �'i� ;%/�1 /.,
<br /> .. _ . . ' ' � Own'cr Phone � >x�� t�- - .
<br /> ' - DO :70: S�:2IT5 �J�LDII TIiZS LZ:7F.-POR CTTY VSF. OHL'1 � �
<br /> . Datc Seccived 1 ' %/�75r Uce� Zone . � .
<br /> ' Plan C;�eck :iur..Ser 75-�� � � Fzre Zone .3 �
<br /> Yaluation � �'G S� �� Occuoancy Grou� �
<br /> Pemit Fce ���� 6 V " � �Typc of Construction � � 1�l -
<br /> Plan Check Fcc 5�f. Lc L' Qccupant Load •
<br /> � Total Pcc Duc . _ SpLl.nY.lcrs Rcquircd •
<br /> ' .. . � . . CITY AF [_.`%Cf;F=iT .
<br /> Datc Issucd /E`-' �7'1 , NPPRQVED '.Fnl7'BUI�CiVG FERIv1IT ,
<br /> . .. � Dal�� '_.Z.����\—'•Dy,—�`'_l_:-__— �
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