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. � . - � _.._ .. ✓: f.�..,t:,� <br />. ..i_i <br />. �. F ' �. �.v' <br />� � �OILDINC PEIiHIT TPPLICATION • �/ �7 • f r� f ' : Y , <br />„ } , ' , ; Jlpplicant To Complete This :orm � .' <br />, � . <br />. �`i ��� S' <br />' if more than one buildinq is to be contzuctcd, submit a separate permit applica- <br />, tion £or each huildin�. �1 separate permit will bc issucd for cach building. <br />• • • ��= 7),� - �� C��1�� -Y ��� Suildir.3 Addzess � {,'3�''/ X6-..•�c� %•L�r�c1 � <br />� . � .C+ - Q <br />•' .� ' j. Lot 1 �- Block �� <br />t . � . �ddicss U-sr''1 �Cirtttc� .�, �c-� n <br />• • �� ��u.tit �j' Phone 3��.ti - �s'.:Fi Subdi4ision (Ylat) e � � }� ` �' ��a1GV ' . <br />' • . ��, �9n / � . • . <br />' �sehitect/Enqineer <br />_ . ti�' =.,� �tY � Phone Hetes F Bounds (Unplatted) � _ <br />:.,.."i t . . <br />:�•: Coatractor <br />.�, • , <br />= ; ' :• ..'' 7�ddzess <br />'f. City Phone <br />_ — . � <br />.- • ��� � State,IScense N�� <br />. � ; '� Lzpiration Dat� �__ <br />� L1: • � • $�TCH PLOT PLA.N BELOS4' .. ' <br />:j :� ♦ � , . • .. . .. . . ••. <br />`, i , ' . ... <br />. . . .; . . . . � � .j .. <br />.� .- „ _ . .. <br />.,...• . e ' . : . �� : .. . . . • <br />_.�. . . . . . � . <br />� j . . � • . � , , ' ' ' � •.. j, _ <br />• -� ;� . '.w�... i.�M. �'� ':. ' .rii� ' . <br />� ��; _ �^...� � - <br />...' ; • ` . . . <br />• . . �i. t . . . � � • . ' . <br />. ': . <br />. . � � r.. ' � ' . : . <br />4``: .. L • , . . , _ . <br />� . .. . • <br />Datc Seceived �l'��x" l7�_ <br />.. - / � . . <br />• Plan Checfi.:iur.ber <br />L <br />. Yaluatian ������ �Y <br />' ' • • ��.�' <br />pemit Fcc <br />Plan Check Fee <br />Sec. 1�+P- R9e . <br />. . . `I.;.. '�.: j <br />8uilding Use ! -� •r:. .. <br />. ,,.� `, : <br />Describe Work ta Be.Done <br />. � 1 <br />IIse of Buildiriq ✓�f-Aca �,�- <br />❑New ❑ llddition (1 Repair/Remo::el <br />�� . <br />Valuation of Construction $�OG C`C2__ <br />PLOT PLAN RtQUI?tG`fE:7TS • . <br />:.; <br />' ZDdicate lot size, nane of streets, <br />•indicate loca:ion and width o: - � <br />• alleys, locate nr000seci ar.d all <br />• existing buildings, sho:+ distances <br />to propertp lines, show distances <br />between buildings. , • <br />yot size X ' <br />'. Lot area ' Sq. Ft. <br />Sizc of Bldq. Sq. Ft. <br />pumber of Stories <br />8asement <br />J / <br />Signed By �'"V ��y/ ,2n � �� - <br />- . (� <br />For � <br />Owncr Phone ; _ , . � c.7S <br />IE-FOft CITY USc O'.iL'L' <br />pGe� 2one <br />Fire Zone -_ � <br />Occuuancy Gro� <br />�e of Constructioii __ <br />Occup�nt Load . <br />�� �% Sprinklers Required <br />lbtal Fee Due � � . • . , • <br />• , / . . . . . . � <br />Datc Issucd `n .. . , ,, , • <br />, . � . . .. <br />R <br />