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_� � � � , � • � ' � DOILDING PLRHIT APpLICATION ' • � �/' .�,C� '� y -' .,, j. .'--
<br />� , , • llpplicant To Completc This 5orm • � //' l •: ,• ,� ' y
<br />, •� S! more than onc buildinq is to bc contructed, su6mit a c azatc /O' ��/j
<br />� P permit applica-
<br />.� tion for each �uilding. .1 separate permit will be issued for eact� building,
<br />' � �°°r � � � IInildinq Address '
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<br />� ' • . �aaress ` `� ,/ )i � ' �,�n�� Lot ,_.- c� � 91ocx uC��l1 �
<br />� � � , ' �tY �� �C51C�', Phone � � -�� '�� Subdibision (Plat) �(li t7i l' `��� i' i��
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<br />_ � = drehiteeL'�E�gineer \\ • . �T . .
<br />_ .' L : . .`:i CitY �_Phone \ �
<br />:,': Contractor � 1).Q � p Q-Q-�1 f iGi{14' 1� n
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<br />,.. �' _ �=�S� :�-�/�, �l ar�f�'1�o�� � O�i
<br />.. �1; �tY�l 44S1(1v-�% Phone 1 i.�,_� �, , , ,
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<br />•41
<br />�'�{ � State.Ltcense Nc�ber ����). -./ J_�
<br />� : .•�I Ezpiration DatB cj � -.�"j(�
<br />�1 : �' • . SRETCfl PLOT PI.�17 DELOr4 • .
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<br />Ketes S Hounds (Unplatted) _ ' .
<br />Sec. Twp, P.gc
<br />{;uilding Use � •'.�'
<br />..y-1,
<br />Descri.bc Work to Be Donp `� �� *� Y
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<br />� ��' �. C. i.,1 � � , � ���i�(\ '
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<br />Ose of IIu_ldirig _ '
<br />[�?ieti. ❑ tuidition Q Repair/Remo�el
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<br />Valuation of Con�truction $ [i Z��
<br />. . PIAT PI.AN P.EQUZRE�L^:1TS . ,
<br />' 2;�dicate lot size, nane of strects, �
<br />'indica:c loca:ion and wir.;5 0� �
<br />� ullcys, locatc proposed aad all '
<br />' er.i�ting buildings, shc:+ distances
<br />� EO property lines, show distanees
<br />. between buildings. .
<br />Lot size X '
<br />. Lot area ' Sq. £t.
<br />�. Size oL Bldq. cQ_ rt_ .
<br />Number of Stories
<br />Basement
<br />�Signed�By �
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<br />Fo�.- �" � �� I'f�-�
<br />Owncr Phocic , �-.t. � �'�-=-) /
<br />�• DO ;70': SC3?TS 9F :DC7 TfiIS LPIB-POR CITY US� OtIL7 `
<br />^ _ Datc S�ceived � U-e�Zone ' �
<br />' Pla, Checl;� :7ur..Ser ' '
<br />� Yaluation � �;�(�, �l�
<br />Pcmit Fce
<br />Plan Check Fce
<br />. � 1bta1 Pec puc
<br />Datc issucd •
<br />Firc Zanc
<br />OcCuoancy Grocp __
<br />�T}�c of Conctruction
<br />Occut�ant Load
<br />Sprinklcrs Required
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