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<br />eurtoixc rr.�r�; ; rrrcrcnrror� ' !
<br />� , A(+plleant To Complete This ^otm �'��: ,�~�/''�
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<br />i[ more than one buildinq is to be eontructed, subm{ti a aepat�te permlt e�flita- •
<br />tlon Cor each bulldin�. �1 e�paratr. p��rmit v111 b�+ is;ued foC paeh bu�ldit��,
<br />� Ovncr : �� � � ,� i � ' . buildinq Addteaa � i%j ,, � �
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<br />t.ddreae ii i'i '/;, . Lotir ,/ tilock /J
<br />City i 1 f'� �hone_�l'� _ �� i guhdivisfon (I�lat) / �.
<br />Architect/Engineer � ,i
<br />City _Phone MeL•ea i Dbundr� (Unplatte�)
<br />Contractor " ' �
<br />Ilddreaa " ( 1 '� :�1.•, �n.,.
<br />City �' .-��'1. Phona '/'� -
<br />Stale Licenua tiaa�er
<br />Czpiration Dato
<br />. � SGE7'CN PI.OY PL,li [l�LGiP'
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<br />Sec. _ 9vp, pqa
<br />Buildfn9 Uga '
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<br />Deacribe Work to be Done �
<br />l>>; , . ����• - 1. �l
<br />. . • —��� y _
<br />osa o£ Huildlnq � �j, , , �
<br />,i -
<br />❑ New ❑ Addition (� RepairJpemc�o7
<br />'Valuetfon of �onstzuctin�t �
<br />' PLOT P1.A!0 REQ�Ip17�,� t.`3� I�OO. OU
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<br />a
<br />indfcate lot sizr_, nan� of �:teetK,
<br />� indlcntc loca;la:� an9 w!�yh o;
<br />•i:�Ys, i:cate pronosed atd aIl
<br />exintSn� Luildi :q., shos� dicianr.c ;
<br />to property lin�g, show daatancee
<br />betuc¢n buildingd.
<br />Lot slze %f x / "��
<br />Lot area sq. r+_.
<br />Gizc of D y,
<br />Hutnber of BtOt�Oo X 6 }�
<br />AaacmRnL• �—""�_
<br />Signed Dy / � ' ,
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<br />Por ' , i / ' �--
<br />„�'Z ---�i f,on•,'_ •_.t.._—_ _�_---
<br />DO :!0^ K72?C Cf:Ot! :!17: I C7}:-iA1 CITY UBS C,;�;.•!
<br />Date ��eci(`ctJ _7 /Ca� Uto 20na - - - — -�'. � � � ,
<br />�-��tnl.�uu��;�,_'- �
<br />Pl�n C.,ec; �7ur.ber �, y -��v 4�,`__ Fitie :OttO _-� 'y� ' `
<br />vnlua�lo:� ' ' ' _ occupaney Croup _ f, ,
<br />Ot-� L.,�.._._ _.
<br />Pecnit Fen 'JZ 7ype oi Construcl•ion �e' �lt , f..1
<br />Plen Checl: Fcc �J3• 8D Oecupant LoaB • "�`�
<br />:ol�l Fae Dne C, s_ �O •
<br />,_ Sprint:lprrr Aaquic¢d
<br />a�te Iasucd ��b ` . , �"� - _ _ __ _
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