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l <br />� <br /> _. ' : ' � DOZLDINC PERMI^' APPL2CATI9N � .'�%� ; y,� � <br />, • '. ' , , � Applicant To Complete This :'orm � %` -� <br /> , • ' I! more than one buildinq is to he contructed, submit a separate permit appl�6g-/� <br /> . . uon for each buildinq. .1 separate permit will 6e issued for each building. <br /> ' ' Ovnet LS�l�)� y� /J Lt�f" Building Address � .S 2�», �_ : <br /> . ' , llddress �D�'� ,�1/'���a-Y� Lot 3�¢ Hlock ���' • <br /> > <br /> . City _GG'lY��- Phone � --/l- � Subdivision (Plat) _��7C��7s �-�f]9� <br /> ' • irchitect/Enqineer ,5� lyt� � . <br /> • �• '"� City Phone Metes i eounds (Unplatted) <br /> _ =� <br /> , Contzactor Sec. Twp, gqe ' . <br /> , , Mdress . � ' , <br /> ' L!; City Phone Buildinq Use ( '�i�dry�pp�� ';:�'' <br /> � ..�. .. <br /> � �i Siate.License Number Describe Work to Be Done ` �" � <br /> • : . �! �p<-atica Dat� � %J�7/�� /' c�rr��t'/'c��� lJ;Tf' <br />� . • /� / � <br />� +�' " � SRETCfi PLOT PLAN BELOT4' • �� . OT /IO�tlG o�Y<r I�Y/UclYl� ' <br /> ' I . <br />� : ; ' ' . , . � , � Qae of Building ' <br />� �� ' : • . .� .� ' ' , I . , � � ❑New �Addition ❑ Repair/RemoGel <br /> . . , : . . . . �i <br />; ; ' � • Valuation of Construction $� � <br /> . � ¢�. <br /> I �"►� '� . � � ' ^ . PIAT PLAN REQUIRy+1E:1TS � <br /> • . ? • . ,-�Q�`� • Indicate lot size, nane of streets, . <br /> � �� �' • � �indicate location �and wic:h o: <br /> � • j . � _� ., . . ' , - alleys, locate pr000sed aad all , <br /> �� ' ,"� . - . . existing buildiags, sho:+ distances � <br /> '• '! t0 property lines, shew distances <br /> � f ' � ' betveen buildinys. <br /> , ' � ' . , �. Lot size x <br /> " ` �, 6f : • Lot area Sq. Ft. <br /> ..•� r.. - �l� r �� , I Size of Bld4• ��F- asJ- Sa. Ft. <br /> ' + Q 1/ � • Num�er of Stories <br /> • �% s i • ; ' Basement <br /> .-.. <br /> �. ': Signed B+ �� <br /> . i , ��� , <br /> • - � For <br /> � � Owner Phone • <br /> � .��e . . . . . .. . •. . . <br /> -� 7------ -------- <br /> � DO �OT S+Z_T: 9ELOl�7 T}I25 LINE-i0R CZTY USE O:IL'L <br /> Date Sp.c01VCd 7 � �r � Uce� Zone <br /> Plan Chec;: ::ur.,Ser ' ' Fire Zone ' <br /> Valuation '� �G'8• � Occuoaacy Group � <br /> �. E^c� . <br /> Pemit Fee �- Type of Construction <br /> Plan Check Fee Occupant Load <br /> � Total Fee Due �u� �-- Sprinklers Required <br /> . Date Issued •���f"� (� � � . <br /> . . .� . . . , <br /> � - - --'-- —- <br />