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<br /> . • i ' ' ' ' ' DDZLDStiC PERNIT TPPLICATION �, � � ' � . • �
<br /> •• � ' , • � � ]lpplicant To Completc This :orm ��. �� �,,f �
<br /> " • i • � '�'//O/7�
<br /> , • • ' ZI norc than one buildinq is to bc contructed. submit a �eparatc permit applica-
<br /> . . tian for cacl� 6uilclin�. .1 separatc permit will bc issu�d Yor each building.
<br /> . � ' pmer ��1 a/c� � �Lt o��y-e,'fJ� Bnildinq Address /j /(, �t,c_c/"�.r�/. :
<br /> ,' . . uazess /3z-o ic�'.e.�.._/-�✓ 7.oe �Sa` a 6 slock a �f 3
<br /> ' � � C1ty �Z� Phone�cS9-`f� `/j Snbdivision (Plat� �tf'(� 4_u_,.,�
<br /> ' • Erehitect/Enqincer � �w �/� ' .
<br /> •:• ` � City • Phone I�tetes S Dounds (Unplatted)
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<br /> � �.�, Contractor ��-L � Sec. Tc�p. Rge ..
<br /> • � � . .
<br /> _. �. . r .?.".dzess . . -
<br /> .. ! ,Cit � Phonc ''Huildin Dsc � � � � • �� �
<br /> Y 4 ,C7a �;��P.� r :•� �.
<br /> :,� , ' , . ..
<br /> � �'�� � Stzte.License Ni:.-�bez Describe iJork to Be .Dcr.e � ��'��'.
<br /> � • :, I Expiration Dat� , � ' '
<br /> . ti ,
<br /> ��' � . • "S&ETCFt PLOT PL?.t1 IIELOW' • ��/S�'-� �"L,�7rL 'UO - 5 C-�GI�G��
<br /> . :� • . . . . �t 7(h1C1 ' � ,
<br /> 7/se of 9uilding
<br /> �• � . ., ' .�� , : Qt:eW ❑ Addition []�pair/Renc::el
<br /> • . .;' ' . •`
<br /> ' � _ " � • . • Valuation oP Con�t=uction $ � o o ' � •
<br /> � • . • ' _
<br /> �� ' - - '�PIAT FLA?d R.QUSi:r"=,::TS •
<br /> :�; . . . . . � � . .
<br /> � . � ; ' , ' + ' ' Indicate lat si.ze, na.:.e of streets,
<br /> .� �• �f � . . � - . � - . ` � •indicate location ar.c width o�
<br /> . _ �_ •� . . . alleys, •lcczte aropcsed a:d a?1 �
<br /> ' ''�, • • ' � .exi�ting build:nas, sho:v dist�aces '
<br /> ,_ i ,'� ' � •�'� - " '� : . ' .••�''� ' - . -.to property lines, �how disL-arces
<br /> , ' .. _� . , _ bet�recn buildings.
<br /> � : _ _ .
<br /> . , . . , ' . • -- l.ot sizc x
<br /> -- � ' • . 7r�t area Sq: Ft.
<br /> ,;, = . - � . . Size ot �31dg. Sa. Ft.
<br /> . ` � , • • � • Numbcr o: Stories
<br /> • � �: • j , . • IIaser..ent
<br /> :..
<br /> � ; Signed 1:3� /�. . �`7, .+z%i�
<br /> • / —==-�- - •
<br /> . Fo� .
<br /> . Owner Yhonc
<br /> ' . . ' DO NO':' tiZT_T� 9�LOh7 TIf75 LI;�F.-i0R C.'7'Y DSr. O7i7,'I � .
<br /> ; _ Datc S�ceiced � l�/7 �-' Uce 7.one
<br /> ' Plan Chcck ::ucScr ' Firc Zonc '
<br /> Valuation ' 2 0�- �=� OccuuSncy Grou� •
<br /> , �f—
<br /> Fc.^.it Fce � 5 - Typc of Construc;:i.on
<br /> Fl�n Chee): Fcc � OccurinC T,oid _ __
<br /> . . �O • .
<br /> . � 'totaJ. Fcc Duc �� . __ �rrinlclr,r.^, Rcqcired �
<br /> .. ' P�ic T::cucd ���7 \^ _ • . . - .
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