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SU:T,C�::7i. PFPA='C .`,nPLICATION • . . j�j'� .$
<br />. , Apo]_cant To Complete 't.`.�s Sorm � /��"j.
<br />' /�f/7%7s�
<br />' no:e tti+n onc buildinq is Lo be contructed, submit a separate p� _t applica-
<br />en for each buildin�. A separate permit will bc issued for each building.
<br />��,� �
<br />� � WlVc�YJi . � i . ; . �i i �; �/ i '� Buildinq Address � � ! � � , �� � � �� -
<br />_ lddress ' / ' � Lot_�� -� Block , �/ '
<br />,, , �
<br />. City �� � Phonc � � ��� SuG:ivision (Plat) j �) ��� •
<br />p/ �
<br />. . Architect /-r :3::��cr ; / . � i'/� s� ���//ii%"�/`� � <'�� .. . '
<br />_ _ `":� City���, ��-�{-- +Phonc ^���'' r �-�i��' Metes S Hounds (Unpiatted)
<br />:, Contractor � Sec. �. Rge �
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<br />� • ' Isddress "
<br />. � _ �� ��/ � � _ ; �� ,
<br />� City Fhone 1 ti Huilding Usc ��� � ��•,'y.>_'
<br />.�. . �. �: „_ i . . � .
<br />����� .'� State License t]c.�' er �•� Oescrib� t�ork to 9e De::e ' �� '' '
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<br />:,\ �i Lcpiration Uat� . __�_! _ �
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<br />_ •� _�..�.��r7rj m � c r �1�3n_�,��— � ' _ . -�. _
<br />� �--' ..� �k 0^.e of Dui�ding � i .' -`' �-`l!' ( . r �, `. l
<br />. � : j �".r__._ . . . . �� -�� . ' ` , - - /
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<br />� i .. • � ,� �,' + • . . . � -t �t7ew � Addi.cion ❑ Repa.ir; Remo5el .
<br />� f : � •�; ;.� � _�tT�' �%aluation of Construction S -��i�t�-
<br />; fi ,� 6 . +
<br />�'� o i . - '-/",��„� :
<br />.,,,,, � � PIAT PT�rlt1 kC�UIR�L:]TS �-� .
<br />. �
<br />' i • ' • Tnd:;.a:.e 1-�`.. �ize, nar.�e of str.eets,
<br />. '.. .' � ' . .
<br />� � r' �i�.�dicate lcca:-.icn a::<�. wicth ct
<br />'� 1 ' •' . � . �'� allcys, locate nroposeC a :d z:i7. .
<br />��� ���' � � � � exi�ting 6uilci:as, sho�.v dis':ar.res
<br />. 1;,,�� � . . � •- �e � .: � �� .. . . L-o propert? lines, show distances
<br />���f��� � �_ � � l , � �,� �, � • , �. betwecn 'nuildings.
<br />'r r . > � .;,. .� _ . '
<br />* �...., ✓ :� �/ �r��. � Lot size �' _x . �
<br />. � �^ ' �� LCtt aied y-_ �� i Sq. Ft.
<br />. . ;� J�; � �. • . SizC Of Bldg. � - � . Sa. Ft_
<br />� , •.. fic^+tcr oi Stori,es -r—
<br />q �� � �(,�( ( /� '�'I�! D.s :unent ' . �� �,c; ,� - -
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<br />• � . -- � � `r Signc. • u•, �i�-: (�,� 1✓
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<br />� � - For � � : - • .�� ��
<br />+j �. ; � (,._. � ..r / /. .- - � � — Otancr . , . Phane
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<br />�' ' ' DO ti7CL" S•::2?T: E�:.Oi3�"i9I5 LI:dE-?�2 CiT: �E_: O21L'I
<br />w�'�� Date ::�ceiced _ Uce 2one �- `-i-
<br />�� �' ` Plaa Chec:: `:u..-.�er � � i'ire Z-�nc � `� � _
<br />� �- � �
<br />Vaivation " ��-'��U G Occuoancy Grou•� �- �� �
<br />/ � � �l\
<br />,�'C> .
<br />PcroiL Fcc /,�'/ � Type of Const?vction �
<br />Ylan Check Fce �G��- � 5 Occupant Load _
<br />. , ' Total Fee Due ;� �� ?S , L� ' , SprinY.lcrs Reqnired
<br />nac� :,���a �!%�v 7S, ' ' ; , .
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