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<br /> " • . I ' . . . �OILDING PERMIT APPLICATION . . �:r��� '� .'
<br /> � 1lpplicant To Complete This ?orm
<br /> _ , .. , /� �� .
<br /> ` Zt oore than one buildinq ie tc be contruct�d, submit a se��azate permit applica-
<br /> . , tioa for each buildin�. �1 separate permit will be issued l:or ea�1 building.
<br /> .,'5,,:- Dnildinq Address " ='- '" r "" ` •
<br /> . " Ouees � '� -
<br /> _ ^ Lot �° '- Block L�`r -
<br /> . iadresa 2 c,;. . �... ;._. J�,, �.
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<br /> "''`. Phone - ' 'r Subditrision (Plat) ;' ''- ,'. . •
<br /> Clty i_,J� ��, - '
<br /> ' • lcehi.tect/Enqi.neer �' � __
<br /> _ !ti . .`�'� City _` • Phone Netes i Bouads (Unplatted) ^
<br /> ' :�". Contzactor !..)�. , C�, , , ., � Sec. �+P• Rge
<br /> �. , . i Mdress --_ . • ' :
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<br /> . ,. Zz,, -t,�� � H,, _ . .
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<br /> . �� � in U �`� � .
<br /> '` City � .•..� . - Phone� . � enild g '• _
<br /> .~� : .'.I. . . �.�.�` �•
<br /> � � "� State.LScense Nccaber Describe Work to Be Done A��� '� ��
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<br /> , . . ' :I LtP1=atiOn Dat� ' ��: '� ' c.r a i-
<br /> ��� � ' � � SICETCH PLOT PLLI HELOW' ' '--"
<br /> ' '. . .:� • .: � Ose of Buildinq •
<br /> , -�___. - -- -- . . . �Ne�a ❑ Addition '�Repair/Remo;:el
<br /> • •� ' ' . Valuation of Construction 5 '��� �' —
<br /> •• 1 • ' ; .
<br /> '' � i. -
<br /> � '• A �� � � 'i � • . . PLOT PLAN REQUI?2�`LNTS . , _ .
<br /> �,.• . , -.�'• , . . . •..
<br /> �. �� � � � '
<br /> � , � : • . ypdicate lot size, nane of streets,
<br /> I : . � . , . . . � 'indicate location and width o: l
<br /> � ( �; •I �� � � alleys, locate pr000sed a.^.d all
<br /> � �- �ti'=� exisr.i❑q buildinqs, sho:a distances
<br />� � � �� ' '�� � .��+. , to property lines, show distances
<br /> • � � � ' `• . ' ' � • betWeen buildings.
<br /> . ' . . . �I, . T , .� . - Lot size _t`__x ! `n . .
<br /> � � . • ', I __1_ -. •
<br /> . � , � . . Lot area Sq. Ft.
<br /> " � ' � . . � Size of B1dg. ' " Sa. Ft.
<br /> �• � ' Number of Stories _ _
<br /> �t . .
<br /> � Basement
<br /> • '.: . i . • _ � � .
<br /> .•:. . Signed By� : '
<br /> •� •
<br /> i . . . For � ,r �.,
<br /> ' - ' � � � Owner � Phone ^ .. ? I F`=,
<br /> ' DO NO': Si:iT_TE H=LOF] THIS LI:7E-i0R CITY USE 027L'L
<br /> Date ceceived Dce Zone
<br /> ' Plan C:�ec;; _7�.Ser �, ' Fire 2one �
<br /> Valnation Occuoancy Grou�
<br /> Pemit Fee Type of Construction _
<br /> Ylan Check Fee Occupant Load
<br /> � lbtal F'ee Due Sprinklcrs Requi(;�qt}' (;;j_F\'f;,jlkl T '
<br /> ' .. . • • AFPf;OVED I.GR 6UilDING PERMI!
<br /> Date issucd , . ' ' '.- � �
<br /> . . ' , . • Da1L.S-�J-�1.j�_7�-DS .l��--�-�'_�"
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