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_ ,• . . ... ! . . . . . . . � 10ILDING PERMIT ATPLICATION � ' ' •. .. , ,. • . . t..
<br /> � i . applicant To Comple�c This :orm . ' }/�� •"f
<br /> � o/Y
<br /> ~ ' It �ore than one buildinq in to be contructed, submit a separatc pesmit appllcaJ 'r
<br /> ' . .
<br /> ' ., ; tlon !or ach�buildinq. 11 separate permit will be issved for eaeh building.
<br /> � � / /�� �
<br /> . ;�� Ovner �ICC�+E � �/eCll�c,�� Dnildinq Address �G.+�� ����1"/2� . : "
<br /> � , s � �Edress � � Lots 4 nloek 3 �Z
<br /> '�.�• . �� Citr P6one c�SZ-'!�.'OS– Subdivision (Plat) itn%`v� �I�us.��
<br /> i
<br /> � . . , �� i� n / � 2�
<br /> _ � • �rehitect/Enqineer L. .r,... W�C. J e� 0 �' •
<br /> T�
<br /> _ •L�� ..`.c'� City • Phone lletes i Bounds (Unplatted) ' '
<br /> , • . .j . . � _
<br /> :.' Contractor So1E' Sec. 4Mp. ' gye .
<br /> �. _;. ,.i• fddres. • ' � "
<br /> _ .i •
<br /> �c.L�� � ' �. .
<br /> f Citr Phone aaildinq Ose • ' • .'�.',,,.
<br /> . •" .1; . �.�� -- ' -,:�,,:-
<br /> y State.Licease Niunber Deacribe Work to Be Done
<br /> . . � . .,t, •
<br /> . : '.i. Lipiration Dat� • �� GLc"c1k. dlhv` �
<br /> �*.1: •' . � 81�TCFt PLOT PLt1N BE7AW' . • hl�!' c0' . . .
<br /> � . 'j. � F
<br /> . � I ' ..C'�f�(v� . • �sa of Buildinq
<br /> ♦ _ j ' . � • ANew ❑ Addition I{7�Repair/RemoGel
<br /> . . �.i ' . .'� • . . • • i' . .. �
<br /> , y • " ' . • . . • Valnation of Construction S /�-!� '
<br /> r�� � . . ���� .. , . �� �� � �� ' � lLOT PL1�N REQUIREFSENTS . � •
<br /> .�, ', , ip. � � � � . . , ' '.
<br /> � ','! • �� . . . • . • . . ' Indieate lot size, name of streets,
<br /> ' " � +' .•I" ' � - '�� ' ` 'i..uic'.:lc: i�ca.ion nu8 :+icth O�
<br /> • � � .�l� ' : i:; �� ;:._: �' • illeys, locate pronosed and all � �
<br /> . . • �:� . . I '• ' ' -�� .. existing buildings, show distances
<br /> � y : .' ' --•�! /� '`+ : . . to propercy lines, show distances
<br /> ; t • �•� � ��'�- - . b=iaeen buildings.
<br /> , . � . � • . .
<br /> � � Iot size x
<br /> • . .'. '.• —
<br /> ..i- ' .�� . • . , Lot nrea _ Sq. Ft.
<br /> .` r: I - . . : . . SNumbezfofl��� Sq. Ft.
<br /> tories
<br /> :: . � � . . • Basement
<br /> .r. _
<br /> '+•: . . _ ' _.l Signed By
<br /> . i� � : U,a��E,�'`� .
<br /> � • . . For
<br /> . . ' '. ' � � - Owner Phone 2S " / ,; �
<br /> -, ' � � DO NOT �:1ITr H'>LOF7 THIS LI:�E-cOR CITY USE 027L'1 � .
<br /> • . / ' � . . � . .
<br /> -- --' Date ��ceived S _�C� 7( Oce Zone _
<br /> ' Plan•C:�ec� :7ur.ber `� Fire 2one '
<br /> • ' �
<br /> Valnation ��� C� ;. �--� Occuaancy Grou�
<br /> Pesnit Fee j i,�_"' Type of Constri•ction ' .
<br /> . .' ' Plan Check Fee Occupant Load . „_,__ �
<br /> , � Sbtal Fce Due �• �G Sprinklers Reqcired � _ .
<br /> � Datc Issued �c�'�CJ�CJ � � _ ' ' ' . . ' . , . . ' . . . t
<br /> , � –�-- .. . , :.
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