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• � :_L <br />• � . ! � � � ' BOILDING PEAMZT APPLICATION � • . ��{ ' <br />" � • Jlpplicant To Complete This Sorm .''! <br />, •' If more than one builiinq is to be cantructed, su6mit a separate permit applica-, <br />., tion for each buildinq. A separate permit will bc issued for each building. <br />, ' ' Orner �g�L� ��S/ f% _S f /� �./ (l Y� euildinq Address "� `� � �} � 'J 0 t� � U 1�1�� J 1 <br />' , ltddzess LJ � � 'I�r1 O r� � �;,, r1 Lot_% ,� elock � . <br />/� . <br />Cit� k VF� N(� � Phone,'t j�,2 ^� � S�i�Subdivision (Plat) [ I t�� �: Gi (� P • <br />' ' 1lrchitect/Enqineer • 1f� Y'C' ��'^ �� C � 1 %'!� �'> h ',vU � � � <br />`"� City Phone Metes E Bounds (Unplatted) <br />_ .} .. <br />� Contractor ' Sec. 'h+p• R4e <br />� . . <br />. ., . . <br />: . � I�ddress <br />- .. - ' . <br />!: �ty Phone 8uilding Use G��% r/.7 � rA '"':.=�.�:.. <br />��� ���i � State. License Number � Describe Work to Be Done Q d N r C[� h i�l^�(�,'� P <br />�• .I L;piration nat� ���?I' P X f.� �! i �i � GJ 1^ Gf •7 /� GJ 19 f� <br />�i : . . ' . SICETCH PLOT PLALI BELOt4' • 1�LL1' � / � �/ JT �� J �� r Q � � <br />� • ~ � Qse of Suilding / /J /' � � J I� �'i � (� � <br />� `� �� . ., , � ❑New �Addition Q Repair/RemoGel <br />- ' __1 . :l ° . • . <br />. . . . . � Valuation of Construction $ � �� U, - <br />• • � • � ^ PLOT PLAN REQUIREI�fENTS .. � <br />,.,,. � . . : . . . . � _ � <br />+ t . ' <br />' , �� � Indicate lot size, name of streets, <br />. � � + � - 2'� y/� �N �•d � � �� �1 �',' 'indicatc location anc width of ; <br />.. j �-�. � alleys, locate ptoposed and all - <br />, ;.�� � `U� �'q /.�Q �� cR.= . existing buildi�gs, sho�a distances <br />'.. -. - - y • . ' . •. - � . . to property lines, show distances <br />' • ' � � • between buildings. <br />� � � 1 . . <br />� �;. Lot size �/9. 9 x ,�..� rK �/ <br />_G� rq,��.. , ,, <br />� � •� � j�/1 �, �/F Ci . . Lot area Sq. Ft. <br />�1 . � . � Size �of -Bldg. G�� Sq. Ft. <br />t3umUer of Stories <br />�� � ` Basement <br />. '4 'r.�.�D�t1' ' � . . , <br />• ��; � Signed By /'�,y��� ru � ' „ . �i. <br />� ' �:� _ ' r� .�1.. <br />For ,� -r• .i �y�o ,!.•v-! !` <br />' " � � � � � Owner P one <br />� *� 9 � u ' � . ._1`•" <br />� � �n�c� - d l � ti�� �; 1� v,� � � � � — 2 � _� <br />� DO t70T Sti:tZTB B�LO[i THIS LI:7E-FOR CITY USE OtIL'1 <br />-� - Date S¢ceived S�%/%) - Dce Zone fZ -'L � <br />—r . <br />Plan• Check Yivabe: 1)'� ZZ a Fire Zonc .S <br />Valuation Occuoancy Group i <br />Pemit Fee Type of Construction �I - h( . � <br />Plan Check Fee Occupant Load <br />� Total Fee Due Sprinklers Requi�Y � �� o� � <br />Date Issued '. APPROVED FOR BS116�INd PEn(vIIT.. <br />� � . • , ' .' Oat�'��:�1: �� _-�Y-I�` � ' <br />