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_' � •• 1 • � . E�plicant To Ccm�letc�This :orm > `;` ,'/ `''�f
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<br /> , • • ' Zi more than one buildinq is to be contructed, suhmit a separate permit applica-
<br /> � . r tion for each buildin�. �1 separate permit vill bc i�sued for each building.� ._;.; / ,
<br /> � . � ' Ovner r R A tti� f-'Li�4t� � a R F h' Q- IIuilding ABdtcss �� � 1 "1 '> >`'1� T.�/ :
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<br /> � , 3ddres� 3t`R � ',�M / 7",�1-- Lot Dlock IG�,n7, r./ ��
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<br /> . City �,✓�>�t C-7 7 Phone ^j 1 - �'''S�-3 Sub3i4is3.on (Plat) s'/N�S �� C R� ,
<br /> ,� � - �Tehitect/Enqineer � �r_ �ANnF_x/ �s�F � �12l3� C:�'7' S� ' � ',
<br /> _ !ti. � `.°i City �✓,tqC'I � Phone �:,�"? � �v� �4�tes i Bounds (Unplatted) ' _
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<br /> ' ;�•: Coatractot l`i:�lt�✓Fe�'t D v � r��/"��^ Sec. SVp. R9e
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<br /> ` j,; r' ]Id3ress � � a �-- `�, �t 1 T'/.t-•.• . ,
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<br /> 'f. City , Phone euilding Use ��ra �, P' i�7 G t� S'I.4"'•: =°� .
<br /> �• • �r� � State,License Nt�a' er Describe Work to IIe Done ��/ N ! n�'G'�� ~ '
<br /> . : '� Ezpiration Dat� ' L31? T w M'r I/ 'T�w u C r /xT c: . '
<br /> ' .��: � • S1�TCH PLOT PL:t7 BELOSP' • • /{ h j-' :u .
<br /> ' ':1:. � • . .. . ' . . � IIse of Buildiriq �
<br /> �~ ' " ' ' ' _ ,,, • �Ner+ (�11�Idi:ion Q Repair/Remo�el
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<br /> ' ' •''• ' Valuation of tor.stzuction S / O_ aw •A'O� '
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<br /> . •� � . . � . . .. � PIAT PLAN REQUZ_RE}IE:ITS . - ` .
<br /> '��� • } � • I t :r . . � . . � . . � '.4,
<br /> '_'11 . ' . . . ' . I . ' .
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<br /> • t . . • • , • . • ' Indieate lot size, nar,.e of strzets,
<br /> •� i . - � •�: : •indicate lacation acd c:idth o` � �
<br /> . ' ,' j - . •' �:: • _ ,; • alleys, locace proposed ar.d all �
<br /> . ;.� ' � '' '' • eXisting boildir.ys, sho:u zis:ances
<br /> � ` � � '.�, �- r- � • � • +°: ' t0 propertv lines, show distances
<br /> � '� j S • .;.� � ' . betaeen buildings. �
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<br /> . . . � I.ot size X � --
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<br /> • . „i- � . . . • � ' ' ' , . 7at area Sq. Ft.
<br /> � • � � �: � � � . Sizc of Bldq. Sa. Ft.
<br /> - • .� r. • . . `' . • Number of Stories
<br /> • :. .� • . • . • : Basement
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<br /> '�,�. • . . . . , . Signed By _�/ {rl..f�t .�-
<br /> � ..'• . .• • �- For
<br /> , . . . pwner Phone
<br /> • ' DO :10:' Si72TE BEZOFi THIS LI:7E-FOiI CITY VSc O�JL'1 � �
<br /> . _ Date Saceived /(!�S � U�e� Zonc � C` � , �
<br /> • ' ic-_ " . �� .
<br /> ' Plaa C:zec;; :�ur.Ser 7 -� �C-� Fire Zone
<br /> ,r� �C . •
<br /> . Valnation �L� c��'�• �� Occunancy Gro� T_
<br /> . . . .. c'Y_ .
<br /> � Pemit Fee ��z • ' ��e of Constructi_c^ _ •
<br /> Plan Check Fcc ��3 `�-�� ' Occupant Luad • _ _
<br /> - �S'C._ . . •
<br /> , � SVtal Fee Due . S '=� _ &pr.inklcrs P.cquirr.d •
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<br /> Datc Issucd ' ' , .. � ';.. �. : . , • .
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