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<br />__ ' I , ' " ' � ' ; DUZLDZNC PERMIT APPLTCATION ' . �/ � � -�•�.' � � y � : : j
<br />i . � Applicant To Completc This :orm �� �,� i
<br />/2� •� ;•:
<br />, •� If cwrc than one buildinq is to bc conCructed, scbmit a separatc permit applica-"
<br />.. Liou for each buildin7. A separate permit will be issucd for each building.
<br />, ,� Ovaer C��t.P' v��� IIuil.dinq Address y�7`�� Xv„�,,,_;�, ,
<br />� � � 1.3dress �'Yi.i �r�z,.;,; Lot % Slock ' ,
<br />• City �,,.a-t._1F Phone" 33-s -�tii_3 SubdiVision (Plat) �
<br />.' d .
<br />_ • Uzchitect/Engineer • �Ji Y p�� %�'y., � Y� i' w �G ..�� z. •
<br />•: � `'� City • Phone Mctes s Dounds (Unpl�tted) ' •
<br />� -
<br />;,•. Cantractor _/j✓ /� �,,.�7, ' Sec. 1wp. Rge �
<br />_ ...� . . .
<br />C • • . � � �IC55 �/ 1/ " �:L C� X!� X c��. ' . . . •
<br />.�� CitY ,_r,,R ,.Gr Z..c., PUone St y•JG �,L IIuilding Usc "',;.'•s'
<br />•�� , , ;:.,�;..
<br />�'�i � State. License Ncnber ,2 � 3 0�- Le2 9 T� Describe Work to Be Done ��
<br />: ..I Expiration nat� '��P, / ' %'�_ ' /,�L�(jJ�� /�.' t, '
<br />��' . • SRETGi PLOT PI.A?] 3EL0[P' • � L °�° �
<br />: : � , . � ' . . • � � Osc of Duildiiig . �
<br />a� � � , .. � � � . ,,, � L�Nev � 1�ddition ❑ Repair/Reno;:cl
<br />_ : i.
<br />'' ' • valuation of Construction $ 3 � " ', ��
<br />..
<br />'. . . • .. �
<br />o.-- . ` . � ��.' .-.. � � • ^ � PIAT PI.A27 REQUZ3F_�IE:JTS . -
<br />y- • ' • . • -' . ' ' ' �.;
<br />� , . .
<br />.� • • ' • ., • � '� � � ' Tpdicatc lot size, nane of strects, �
<br />.:. . ..''' • _ •. ` . ' � ' •indicate location and wir.th of � -
<br />,. _ ��� .. _ , : allcys, locate pr000scd ar.d all
<br />. • :'� . �_ : � : . ' ' existing buildinqs, shc�.a distances
<br />'-•q �'-- bo property lines, show distances
<br />, ; ? • � � � ' . - , bett�ecn buildings. .
<br />: ' -• • . . .
<br />. , , ..• , . ' . . ' ' , Lot size x '
<br />-•_. � . , • . , . Lot arca Sq. Ft.
<br />. �, = . . ,. � ' � .Sizc of IIldg. Sa. Ft. �
<br />�1 , • • Ntuaber of Stories
<br />. • :: . j � . . . . . . • Da�e�ent �
<br />•:. �/
<br />`�': r Signed IIy Q.. � �7 �`��
<br />i. . . , , � . . /.n
<br />. '_ . For �!l a� �rti.� .
<br />,' - � tr.�ncr Pho 3� y' 3 �
<br />j{
<br />: _ _ Datc �eceived ` `Z Z.�
<br />' Plan C:�ec;; :lur,Sc
<br />Valuation
<br />� LTX��J- � G
<br />. . . , • �n�.
<br />Pemit Pcc �`�• '
<br />Pl�n Checl; Tcc
<br />. � ibtal I'cc nue 7 ��- � �
<br />r
<br />(11iC i5.",UC(� ' • �/ z�� �
<br />. . � —7
<br />D�e•2one •
<br />Pizc 2one
<br />Occunancy Grou� _�_
<br />Type o: Con�truction
<br />Occup�nt Load .
<br />GpriuY.lor: Required
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