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<br />, � . IIOILDING PERt1iT APPL2CATION , ' , ;xj
<br />�' � ' , • , Applicant To Complctc This =orm ' �'• �� ,
<br />� . . .;`��s,
<br />, ••� It norc than onc buildinq is to hc contructcd, submit a c aratc �
<br />� p pernit applic�-
<br />. tion for cad� truil�linq. A separatc permit will bc issucd Yor cach building.
<br />. �� Gmer � l i P Gc t d 'h F�� -. ; c!r'> o-. � Buildinq Address _2_ i 1•V v� t' . i�'l � a,.
<br />,� .. Mdress � � l y v� r�; n i• 1. Lot � c- tG IIlock �� �i
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<br />' s•it `� �'Phone � � .
<br />, Y S. 7>r' : F.i7" __,�-5' ;?t:Y Sub3ivision (Plati �` c i,1r. c If!i •
<br />. ,
<br />' • �schitect En �
<br />/ ginccr __ ,
<br />- _ :'"_� City Phone .Hetes 6 Doun:;s (Unplatted) � .
<br />� �, ; Contractor a s�� ( f.� Sec. 1t,p. Rge ..
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<br />- , •' .73dzess � . . ,
<br />' -atY Phone : �
<br />'fiuilding IIsc � q y ��
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<br />�t � Sttte License LIL.^iber Describe S9ozY, to IIe Dor.e '����-�'�
<br />' : : �i 2�iration Date ' � [�., Oti`�, c�. 7 � � . .
<br />��' �� • SfiETGi PLOT PL:.!7 DELO?J' • -
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<br />, ' � � • '.• � ' ' _ • , . � .
<br />: { , . - ' . IIse oL Sui.l9is.g
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<br />� • ; �11ec,r ❑ Addi.tion ❑ Repair/Res�c;:c1
<br />� • . `iliK�' : � . ' . ' .`
<br />• , `� �T j'!-n; a. • • . I • • Valuation oE Cnn�t_cction $ 1 �� ��-• ' �
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<br />� � . _- - Fl . � ' . -.:PUJT PLT�N SL_�UL?:L'}i:\TS . .
<br />` • � 1 ��b �J . 1 . . ,
<br />. •.� I .r �.. �(� ' �' �.' xndic��tc lut si.zc, naMe nf s�zcets,
<br />. � . 1 ! I 'S1 . -� ✓ �' ' .l�.l �ra 7.jJ�,r� �8L' 'indicate ].ocction ar.c ::icr>> o� .
<br />- ' � � _ -- , `_:. � �^ �' "� :�. • � ' allcys, 'locat� propo�ed a .,a. a11
<br />, ;.' �
<br />. .._l . .i,- �. � _C :�T' . _' ' _ ' .exzsting buildi :as. snosi dist�nces -
<br />. .� � (.:'` I .-J���: W:'( �'•�j•. _ . . -.to pxopertp lines, chow distances
<br />. � : �A � '� �.-. � ' . betxecn buildi�gs.
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<br />. , . ' I . ' • Z.ot size x
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<br />"' � - ' � . � . • , J.ot ar.ea � Sq. Ft.
<br />` ' � '� 5izc of Alcg. - Sa. rt.
<br />� t . ' • Nm�cr of Storics
<br />' •: �S. . • ' IIasenent
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<br />" = � Signed D3 �%'�7er� "% �
<br />_.� ' . '� . �--�i_�-{:... :y-- , 4�J=- �-...
<br />' . � . � � For •
<br />'. . ' Owncr Phonc
<br />.. DO :10"' S•::2?TL 9::AS7 THTi S,I:]'r.-FnR C'7'Y USc 01I7,7 �
<br />; _ Datc �eceived ___��~ � U�e Zone _ _,..
<br />' rlaa chcck, t7u-bcr ' P•irc. �onc ,� -
<br />l'aluation � ' �i�. � _ Occuuancy Group �_� �
<br />Fc.^.+it Fcc ��/ � 7ypc �f Construc;:ion �� -�_
<br />rl�:, ri��o}; i'ec � OcCurnnC I,oad •
<br />... . 1;\:ti?. 1?ec Duc 5/� ---•- �priul:lc�•; requi.redC� i- .
<br />�-e�'�'v�i2�- --
<br />n:.;� �::::u; a---.--_----____-•_-� " ' �PPROV[D FO(j BUILDING PERMIT
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