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_ . . . � } . � , . , . • . . . EQ2LDING PERHIT APPLZCATION , ', � � �� 1 � �, � � ' • �'�� ,
<br />� , • �pplicant To Complete This : orm . `/• �•�%�: �'
<br />" ' � ' /
<br />,' If eoze than one b ildinq is to be contructed, submit a se arate ' y
<br />. p pezmit applic��j>
<br />..; tiop for e a c h b u' i n q. 1 1 s ep a t�ermi t will be issued for each buildiQng./� �
<br />. . • , � Owec �C2c � Dnildinq Addr ss �' /T �� /( (�C�✓L :
<br />� . + �ddresa � ' � � S Lot N—� � Block ; a � ,
<br />, � City 'LvC'/E Yhone �`/-,'1%6� 3ubdivisi—on �at) ���(7xCc�i+-/Y,7n.�1�?,�13.
<br />- . � � , � lrchitect/Enqineer � �;cX� 25� �6 �zY " : �1'0 � (%�1 � r� 2 s':
<br />_� i,, •�='� �itY Phone ltetes i Hounds (Unplatted) ���
<br />� ;,• Contractor • l�ff /'�G . � See. 1Vp, ' gqe
<br />�. " y _��. —� . , • __
<br />_:•. iddress . . .
<br />: f �i' Phone Snildinq IIse _%7,A/"/� s�o� �t A�,�. 1: ►. .
<br />`L . : .
<br />: .•�.(y� �� State. License Nis�ber � ' Deacribe Work to Be Done� �
<br />% ""� .
<br />:. . .I. L=piration Dat� ' ,�[� ,ck.�w �5'1,{�i•5 �9c�,ty,�1%. , L�—�
<br />,� : � , . ,..��n� /� . .� )p���r t"""^l :
<br />� 1 SRETCFi PLOT PLAN BEIAW' • 1` .G� X4 t.nWi [..i G �ri �;,�a.�'.j
<br />y,' . : � . �'- 5 � /:1�:. . ,. � . II�a of Buildincj�X /o� � o.� � ' G�
<br />! i • . .. ' �Nev ❑ Addition � Repair/Remoiael �
<br />� . �,i• . ; ' :, o� :
<br />• i �' . ;�•' ��' . • Valnatian of Construction $ �)G� ' "
<br />: � � ���y�; - j� _ �.
<br />�'-' .. �':.G4 LjIC'I�I .• � � PLOT PLAN REQUI?tEPffiNTS
<br />-� '• , � - . _ - � � . , r � .
<br />� . J ''�^. . s . • ' .a
<br />�� i ' ". . ( .� = � ' �, ' ` ' � ' ' Iadicate lot size, name of streets,
<br />'� � � � - ' •indicate location and width o£
<br />. ! D �
<br />' •'.�. . 3 . : . � := • illeys, locate pronosed and all �
<br />' • � ��� �- • � � � - ' � ' lXisting 5uildi :gs, show distsnees �
<br />+ � ' ` �� �"'�! � - ��'� . to property lines, show distances
<br />. ,t � . . .
<br />: ' i .
<br />� � �. � ' between buildings.
<br />' . rl3'-9 . . • l.ot size SZ> x /�� . . .
<br />.'. . .
<br />.•i- � . . . • LoL area Ov
<br />, Sq. Ft.
<br />r.- ' � � . .� Size of Bldg. /� Sq. Ft.
<br />�s '° • ' � Number of Skories
<br />'r _ ': • � � • ' ; :- � , ; Basement `
<br />'+';'� . �" .` Signed By _ '- ��/
<br />. i . . . . , • ��;
<br />�:
<br />� . ' • . - . For ,
<br />. . . . . Owner Phone _� Y -- . C .
<br />��.� � DO NOT S�nITL' BELOS7 TNIj LISE-c'OR CITY USE ONLY '
<br />'
<br />--� �-. Date �accived � - �� % I. . � Ote Zone ..
<br />' , Plan. C:�eck :7ur,ber / Fire 2ane -
<br />Valnation � '��p. � Occuoancy Grou�
<br />. Pemit Fee _ - S • ��� � 1Yrpe of Construction � • .
<br />�. , ' Ylan Check Fee � - �OccupanE Load . � � '
<br />.;�: Total Fee Due 5i'�� Sprinklers Requ' ed
<br />Datc Iswed ' � " i �/'�J �+ • � / �
<br />' - . . � (Z �//('''� ��`' � � • c-; �/[ ♦�--�-;'.
<br />. . ' • ' � . . . . . �.. �. �i/ ' :�""' 2L ��• S/ �.7J • `
<br />' . . . � � • ' . . �/ ' • ;
<br />� . . . . ' . . - . . � . � . . �__n.
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