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, '- .._ _ r .._._ � � <br /> DUILDIN"' PEAMIT APPLICATION / ��J/� <br /> ' � � � �� Applieant To Complete Thia Form . <br /> . . . - . - �/.�=-� �s <br /> � If more than one building is to be conetructed, aubmit a eeparate pezmit <br /> • , applieztion for each buildiag. A aeparate permit wil.`. be ieeued for each <br /> building. `�, ` <br /> pwn�r i�P\Zi;, W ��U(1\t 1-� Building Addreee ��� ��-✓'U//�(/���JL ' <br /> 7 ��Uc`t�t=� Lot � Block <br /> Addrau �0 �. ,/ � <br /> Ci {� <br /> � [��F'.{�F l�'j� Phone�hTi.-1��' Subdivi�lon (Platl ��C1'�oP\Wecn <br /> Arcbitect/Engineer 11 - `�-� '"nT''�. - , <br /> Cit� �=-��r�F=1� Yhone��1` '�ti btetes k Bounde (Unplatted) . _ � � <br /> Cantractor ���H�1�i� �l�1Cr1�� See.?'wp•_�Dg° — <br /> Addres• ~� 7�� �UC_�M06i�- v <br /> C{ty �-�'t`-P.�=\� Phone��h`1- `���� Building Uee \\1=51�� 1\Cl- <br /> � St�te.License Number����� 1�_3�� Deseribe Work to be Done _ <br /> EipiraHon Date C� � �� 5 _ f�;���Y�1C� <br /> NFw Res�or��er_ <br /> I . <br /> I �KETCH PLOT PLAN BELOW • <br /> � �\\� �ES\DE�\CC-- <br /> � /;� 'Q�e'oE Building <br /> I �� <br /> �� ^ ' Y . J�New QAddi[ion �IIRepair/Remodel <br /> i / \ <br /> 'I � . � .. �� Valuation of Conetruetion 5 1��� FtN��-- . <br /> � . — <br /> ,-- -- `' � � PLOT PLAN REC���ENTS <br /> f-" 1 __ � <br /> � 4 � � _ --`-� .� Iodieate lot size, name of streete, <br /> i y� ��� indieate location and width of alleys, <br /> o � -� ����� v . - loeate proposed and all existinq <br /> o __- � sQ' buildings, show distances to prop- <br /> � � - ��� '�O � erty liaes, ahow diataaces between <br /> '� �' � � � � r,� btl�idlLge. <br /> � ='� <br /> � �`p� � .. .9 � ���. ( .,Z Lot �ize� X - <br /> j•� - <br /> ` �5-'� • � �` �c .��� �G,o;.c� I',rr2�,; sq. Fc. <br /> � , � •, `t � ----�. ���—sy. F�. <br /> h1 -� �'9 � .-- _--� . Size of bldg.�_ . <br /> g � �. <br /> �� � �� � Nnmber of storiea <br /> � ;� _ ..�L . � � , <br /> � , F� Ba�ement �A �1�11�� <br /> . � 7 , <br /> � - � .� - Signed By `?`-� ` . Date �\ �\'� <br /> � I�..For RF, � . J � Ph�o_n`e_M �_- \`�`-lt\_ <br /> -- �- ----._—. ._ `r ` . <br /> � <br /> `7���.����1 DO NOT WRLT.E. BEL01. 1'HIS LINE - FOR CITY USE ONLY <br /> � �� Uee Zone� s FiaM��'� I�s�-`-�` a.�4. <br /> Date Received � , <br /> ��'�� Fire Zone 3 <br /> Pl�n Cheek Number / -� . <br /> ' Valuation_�� ��� '� Oeeupaney Group r <br /> Permit Fee <br /> � �'J�7, � Type of Conatruction � ' h-� <br /> __�j�j_� Oecupant Load <br /> � Plan Check Fee � _ <br /> Tolal Fee Due l�L" L� � Sprinklers Aequired _ <br /> ���. -L � .�- . ���� Fa�- <br /> iHlf�l�ltor-1 oM �'-1 <br /> Data.Ieeued_ � � ` 7� Zt� '7 2ar <br />