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<br /> . ' .i � — . . • 1�ozr.nt[:c rcnrsiT nrrr.icnxzofa • . . , ,;:` `, ' '.�:�.�T
<br /> - . .. � . , $Ppli.canL- To ComplaCc 'Lhi� Yorm . . . .. :'!, .
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<br /> . • ' xf »orc th�n onc biiildinq is to bc contructcd, submit a �eparatc pcirmit �pPlicn-
<br /> � , , i1o. kor cach buildi:�.�. A separatc petmit will bc i::�ucd Yor cach buil.ding. .
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<br /> . • Ddner � L,11 �1�C� E�'-'�'� ) IIuildinq ncldre^•� .� �Q%� �� ��-f �v�(� l i;_ y
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<br /> � � Z�dres� �?�(� 1 �'\���1V��C',�G_ � Lol• � IIlock �3� =[� 'Go '
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<br /> . City4 1�( 1�4�,. phone'��-i'���(% Subdivzsion (P1aU � ",y� r�'-��-1-''�S-�
<br /> ' • Iscliitect/Engrncet \ • �
<br /> _ •: ':.S City _�_ Phone \ I�Setes L L'omids (Unplatted) _ :
<br /> . . .,'. Gmt-ractor�' I �G �i9 �K . ,4�1t��,�c �C��.'1 •^+�C. � 'h'�• . n9�-' — .
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<br /> �_' i' • i� �LdIC55 �� r '1 �' ,�Q�1��� 0 h1 �_l.�-A . .
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<br /> � ! _.�ty �r�.Phonc��'i- I�I -"llui.ldinq Use � � �'�';���. .
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<br /> �� ; ' ?���-'� Descri.Ue tlorl: to De �Done ���
<br /> �•� ` State License �mtik;�r=�l�7i '01- //`�" - /'
<br /> : . ��.1 E�Pization DaC� ��- l - �__`j � ' � 1 Q � t_C� �-1' (�Q_�_� S�-"� ( CLQ41 �.��
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<br /> . -.� ' '� •- SPSTCII PLO? P7.A?i RELOId� • . , .
<br /> . � • •� ' IIse of IIuildir,g ' �
<br /> 6. ' `'i • , . • _" � _ - . ; � [�New ❑ Addition .,Ii] Rcpair/Remocel _
<br /> _ . ` � C[� ..
<br /> ' ' ' • • • , , , . . tTaluat n of Construction $ �-�(Y�.
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<br /> � � ' . . . . � [S'SAT PLA?i ni.QUIRLii.:]TS . '
<br /> " � .. ; . . : � • . • - . . " � Indic: tc lot sizc, nar..c of. trcetr•,
<br /> . � .• ,� . = . . . •"+ . .indicn�c loca'aon �ar.d ;�ri-dthJo�
<br /> . i .. _ ;•:: _ ' . . al].c��r., 'locaCc arr�po�ed a.-.d a'.1 .
<br /> �.�� ..� . •. . . • . � . .e3:iati.ng buildi:gs. shc:u dis.�;:ces
<br /> ; r . ' � - - - .q . • �. • .1i . . . -.to proper.y lines, show distancc�
<br /> • ' �; - a . _ ' bet�acen buildings. .
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<br /> . . . . bot �iize X _
<br /> � • � � '. � �. . . Lot- area - Sq. Pt..
<br /> � � '� � � . . � . �Size of Uldr,. ' Sa. Ft_
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<br /> : � . . � t7w�bcr of tito!-irs _
<br /> . '.� • . , . ' ' IIasracnt . --- .
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<br /> a ., �-- '. SigncdT.y�,
<br /> ' . � . � Tor }C � -�.---��.'� �o-ti.L_. �
<br /> ' - , ' � � ' . Owncr Yhonc �i,��.��
<br /> . • . DO 1:0: l{:2�T- DET,O'•] �THI; LI:Ii.-FOR Ci7"i DSiC Oili.'L � _
<br /> ; ... Dzte `:cccived _I / C_a �� \ � U:.e� 7.on^_ � _...
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<br /> ' Plan C:uc.`. `7ur..!�cr ' ' Pirc Zonc � _�__..
<br /> �'i' C C .
<br /> � l'aluation ,�'�`(��^%.. Dccup:uicy C,rou, __
<br /> . . • 1'crniti Pcc _ �J . C9 CJ� � . 7,y�ic �: Con�:trucCion � --
<br /> Plcn Cl�ecl: Pce ��---- Occujr,,nt I,oad y . _
<br /> , iUl�l Pec Due � . �`' �- � � . SpiinL•lcr� Hequired ��_ � ._._ .
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<br /> . ' L`,.Lc Ss;ucd _;4 25�.�.�_._ . . . . � . . • � .�. ' . . .
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