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<br /> . . � , . . ' � Applicant To Complete This _orm � � ' " � . ' '�';`1 ,
<br /> . /� . � �"� . .
<br /> , �;;s' �, , . . .;
<br /> 1! more than one buildinq is to be contructed, submit a separate permit applica- `
<br /> . . • tloa for each buildin3. �1 separate permit will be i.ssucd For caeh buildinq.
<br /> . , n • '
<br /> • � �VIIGT �`�C !/1��i.�/'/ T -� . (
<br /> ` � ., �(i uSC"� Huilding d�dress ���,)�(.� i ��e����rt �(4
<br /> t • . 3ddzcss �-
<br /> . • Lot S Block •
<br /> �" • , ��' Phonc Subdi4ision (Plat) �Ll� i' '� '
<br /> � - % L Gc'" •
<br /> _ lrc6itect/Enqineer � . . �
<br /> _ ' `L" � . s � �tY /-Phone �- . • ' .
<br /> ,,, •. �-1 Hetes i Dounds (Unplatted) •
<br /> - �:,'; Contractor � . -
<br /> .., , �/ciE'q2.S /�c hoof-'iN� Sec. ,
<br /> - : �'P- Rqe
<br /> _ ;, : '- Iddress /,S �� L1.�,4�Nu�' , • • —
<br /> . • r ;
<br /> +f atY �U�('C � Phone `�S�-7�%,S L� Bnilding Use r l(�^ . , • �
<br /> .::5.�J•?��.
<br /> ' ' � �1 � Sta£e bicense Ncaber �1Z3- QZ S'L Y'�� _• �; ��
<br /> , �J � Describe Work to Be Done �Gi �L�:;=iY✓G
<br /> ; • �1 hpiration Date � ��jt�i, ;- c,: ,TN � ' •.
<br /> ���r1�'t �
<br /> '`�� • ' '"i:TCH PLOT PL,17 DEL0f4' � �
<br /> •• l •-� • • .. . '� • • � • .
<br /> _ _ IIse of. Buildirig ���l��
<br /> . . . ,
<br /> �� : . - . . . . " •�Nea � .
<br /> . . .j• ' - . ... � Rddition �,Repair/Remo:Zel
<br /> • . . . � � �
<br /> =� • • ;' "• Qaluation of Construction $ � 5����L� .
<br /> ��� . •� _ . . . . 1 . . .
<br /> ..�• . . . . . • '., . - � PIAT PLAN AEGiJI?2E�Lr:ITS
<br /> � . ; . • . • _ ' ' � . � ' ' • f :}� .
<br /> . . '� i . � � ' ' • �• ' ' Iildicate lot size, nane of stzeets,
<br /> _ :' j � ; -- �:: . • . z, •indicate location aad wi.:th of �
<br /> �. • .-� � � . • � �� - j= , � ' alleys, locate prcoosed ar.d all � �
<br /> . . i _t . ' �• � y : • '�� - Cxistin, bnildi:gs, sho�a flistances �
<br /> •• ' :o propr_rty lines, show distances
<br /> � ; �' _. . . be:.ween buildings. .
<br /> . .;. ' ;� • . . . ' Lot si::e X ' . ' �
<br /> ;..- • , .
<br /> ' - � ': '. Lot area g g .
<br /> . . �.j �'. . � . . . . ; ' . . Size of Blcg. � Sa. Ft.
<br /> . ;: .
<br /> ' ' Huaber of Stories �
<br /> r. . • l ; - . . . Sasement —
<br /> ' •::.� - . � .
<br /> _� � � _ . ' : • . . Signed By ,�^,��,_
<br /> . _ . . - � �
<br /> • . . . . For
<br /> ' _ - . . � . �, . • . Ownei Phone �i z -,..-.-�.
<br /> ..� ..... . DO :fOT Si:i?TT_' BELOPI T8Z5 LI:dE-POR CITY US�Ot7L'1 � � .
<br /> : _ _ Date �eceived �C� • 7 (� Dce• ione �
<br /> ' ' Plan C:�ec;; ;7ur.Ser �---� • Fire 2one - •
<br /> Valnation � �EC�^,���' � p��oancy Cro� '
<br /> Pemit Fee � �-�/. �' % qype of Construction .
<br /> Ylan Chec); Fce Occ�pant Load .
<br /> ,
<br /> • ; ibtal Fcc llue L-Q, C�� - Sprin);lcrs Required ' '
<br /> Date Issucd _ •(C.� 9�y � • , . , � • . •
<br /> . . , � -_,., . • , �
<br /> • ... . , . , .. ''• ' . ,
<br /> . _ _ . . f
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