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. . _ � �_ . _ _. _ ___ � <br /> i <br />' _. � � ' DOILDINC PERMIT APPLICATION � ' � > �'' � � <br />, - . , llpplicant To Complete This :orm <br /> / � �/ �� ...,j <br />'i , • If more than one buildinq is to be contructed, submit a se arate �/`��V <br /> . . 1on for ea buildin P Permit applica- <br /> g. A separate permit will br issued for each buildin <br /> /; <br /> '.�Ovner �1 G'!cJ L Buildinq Address �_ �-S �% [��j,i,Z� ;_= <br /> . � , Mdress i/r'%�� ��a,Z� ,i`� � Lot :3 � � Slock �` �6("N c5l_j . <br /> I + ` <br /> City �j J: O �a hi/�;�one��'��� Subdivision (Plat) ��,�ii / �O r- /��r�� • <br /> _ ' . ' )lrchitect/Engineez ` /.r ? ,^. ,.-. �,-- �b ( ,' ,J' l, LI_ /- 6'� J-Y /"r� . <br /> :..I ' —� <br /> _ -y City Phone Metes 6 Houn3s �(Unplatted) <br /> . , Contractor �j�%,, i/j -C ) ' Sec. 11ap. Rge <br /> � ' ' )lddzess . <br />' ' City Phone &uilding Use ��? ' <br /> l f �f��: j� : :�- <br />� � ��; � State License Nc;aber � � `'�;�'' <br /> Describe Work to Be Done �J�/G <br /> i . ` .y r �� <br /> ; i Hcpiration nate ' _j�Y�/� / C. nv i� f/ �i o c,. �, i70 l—'� <br /> r � . / i <br /> =�: , . � SRETCH FLOT �I.AN BELOf9' • �/.�JA:^CI 7`'�C' `/"0 a. f O � �y j,f Cvy// <br />� � . I . • , ��, � / <br /> . � �se of Building ' <br /> ;:1 . . . -- <br /> �� • �.. � � � � � , . . � CINew ❑ Addition � Repair/Remo;<el <br /> . , . , , - . �„� <br /> � . . � � � � . � � Valnation of Construction $ � .'.� �� " . � <br /> � � g; <br /> � � . . � ' � ' PLOT PLAt1 P.EQUIRE}LF\TS . �� <br /> •. � � � � � � � � , � Indicate lot size, nar..e of streets, � <br /> � ' � - �indicate location and width o: <br /> � '� � � � .' . • . '. � alleys, locate pr000sed and all <br />� '. � .' , . . . exicting buildir,gs, sho:a dis:ances '� <br /> • � � ' �! . • . - - . to property lines, show distances <br /> � � • between buildings. <br /> � , � . ' � Lot size X . <br /> i ..: � <br /> � Lot arca Sq. Ft. <br /> �' ��- ' � ' Size of IIlag. Sa. Ft. � <br /> ' , � • Numbcr ef Stories '� <br /> • � '.: . i . • � Basement _--� <br /> .:. <br /> � ` j! Signed BY I/ /L /� �i���l.l�firv"� <br /> ' - For , J n <br /> —__ C�:J.�9f'' �'`-C--✓�, �---/ <br /> � Owner Phone ';] � - J <br /> DO NOT F::2rTB B�LOt! PFlIS LZ:vE-?OR CITY US^c Oi7L'L <br /> Date Seceived �t� � J ^ U�e� 2one <br /> ' ' Plan C:iec:: :7u.:.Ser � ' Fire 2onc • <br /> Valuation �7 S. '�� <br /> _ . Occuoancy Group <br /> Pemit Fee S • � Typc of Construction <br /> Plan Check Fee Occup�nt Load <br /> ; Total Fee Due S. � Sprinkldrs Required <br /> Date Issued � �o��/7J� � ' • . � <br /> • . -T T . . . , _ <br /> i <br /> � <br /> ' <br />