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<br /> ' � . � J � -. � � ' EUILDING PERMIT APPLICATION I. � ' l�c3.L +� •
<br /> - � �� � ' � _ � Applicant To Complete This ?orm 1��/�'� �
<br /> . ; . B��Y/�s'
<br /> , • If oore than one buildinq is to be contructed, submit a separate permit applica-
<br /> .. , tlon for each buildinq. A separate permit will be issved for each building.
<br /> .� . � ' � Ovner ��: �✓ �'c..'. $f5 _ Buildiny Addzess .� ?/1 6�Q'�;Y ;,�2,'
<br /> � , Ilddress •� �f i t,1y7r.--��: Lot ,-) '� � Block �_ .
<br /> i
<br /> City =:,�e,.�-,� Pfione p L -2 /. C b (� Sabdivision (Plat) _ �
<br /> � • 1lrchitect En ineer � - �
<br /> _ / s' r a�a� << f�.�ti��
<br /> `"� City — Phone Hetes s Bounds (Unplatted)
<br /> - �t /
<br /> . � :,� Contractor �(C�:.:.�` T ��---.�� ���"-"-4-- Sea. 1Wp. � Rge ..
<br /> .. . � address �, 'f"1� ,.7 rz_ S ��r • � .
<br /> _ '; City , . �-�. Phone ) . G `� �y Buildinq Use � � . ��:.; :�:',., .
<br /> . .��� . , , s.
<br /> �� "- Stzte License Nur�her �l y 3 Z L- �c��• pescril+e Work to Be Done � �� ` . �
<br /> :i
<br /> r • : ;I L�cpiration Dat� '
<br /> -1 : � - . . SICETCH PLOT PLAPI BELOSJ' •. . . -
<br /> _ . . i ' • , .
<br /> ' .. � IIse of Huilding
<br /> �,2y'u"�Q' � .
<br /> � . : d!1 , _ . . �New ❑ Addition Q Repair/Remouel
<br /> ' � �e� .
<br /> �' ; _ • • 'Val.uation of r_onstructio❑ $ --? 7� —
<br />, . .
<br /> �.... � 9�. (��� •,�. � � � ' _ � P7AT PI.AN REQUIREIdEUT.; -?�,e,.t,�.����
<br /> � • ,S ( '��I''�`�' '`' '��K'�. . � � �--.
<br /> ' � " (.' I Iadicate lot size, name of streets,
<br /> � � ' " � J . 'd1 ' � �indicatc location anc width of
<br /> � p '
<br />, • . � � � • � (�r �Q �• . '` , �� � alleys, locate pr000sed and all � ,
<br /> . • �'_I . :_. �/_� � , � existiag auildings, sho�o distances
<br /> , , C�-�r . .•'+ to pr.operty lines, show distances
<br /> � ' � . � • . between buil3ings. �
<br /> � . _ .
<br /> � ' 'At siz� x
<br />� • �.. . � . Lot acea Sq. Ft.
<br /> ,;, = r�� _ �^- • � Size of Bldg. _ Sq. Ft.
<br /> ,,, + U:p,�.�
<br /> Number of Stories
<br />. . '.: . j• � . � . � Basement
<br /> :.. ' _ .__�— . /. �
<br /> � . — ��<�S-a%`� Siqned By %�r_,�,`;L� >' ��i��
<br /> • �'. � For c'_�. CD i7 /F' �:
<br /> . . ' . Owner Phone �{L � r,�. ��;, .
<br /> � DO 'AOP IiZZT1'. 3ELOt7 THIS LI:IE--FOR CITY USE Oi7L'1
<br /> - -- Date Seceived Uce Zone
<br /> ' P1an�C:�eck :Iur.,6er � - Fire 2onc '
<br /> Valuation Occuaancy Group
<br /> Peznit Fee 2ype of Construction
<br /> Plan Check Fee Occupant Load
<br /> . � 1bta1 Fec D�e _ Sprinklcrs Required
<br /> Date Issucd � , , _
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