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' � ; lOILDING PERMI_' APPLICATION . ' '� ' ,� <br /> � ' . Appllcant To Complete This ?orm � � � ..��_ � <br /> , • ' Zt more than cne buildinq in to be contructed, submit a separate permit applica- . <br /> . t10n �or each buildinq. .l separate permit will be issued fot each building. <br /> ; � Ovner �9"/C/��.f�� �!%S�0/I�� Huildinq Address �� : <br /> � ; sear�t�3 S�/b _S.t�o�GC-'��.s/ /�tiE� �e ni�k . <br /> City �llj.� PhonP����� Subdivision (Plat) � <br /> ' • irchitect/Engineer � <br /> "'� City Phone Yetes i Bounds (Unplatted) <br /> - - f n /'' ' f .. <br /> � � ,-,� Cantractor 1�,�//1� G/IVi� ���/�9'�� iWp, � Rge � <br /> . MdtesS I�-�. G=.Y/L � / � <br /> > �+ /J � <br /> ' City�,(Ji{J/,(101'�OPhone 7/ /-� Buildinq Use /C sf�3 . `�•;:q;' _, <br /> :,� ^,� . . . - �: <br /> �� State. License Number C�/A/,�/5�2�[� Describe Work to Be Done ^ " . <br /> . �, <br /> � ; .i Lzpiratiun DatE ��3$ —7 y� ' /i�'Tlr}t� �Ga n�1�'� ' <br /> �1 : . . ' . bREfCH PLOT PLAN BELOf4' • /� � <br /> . ' : i : � Ose of Building /r�3 ' <br /> • � � . � �qNew ❑ Addition ❑ Repair/Remodel <br /> / \ <br /> ' . • Valuation of Construction 5/�� . <br /> .�.. � � , . � ,� . • - . P7.OT PLAN REQUIREt�tENTS _ _ <br /> +n . , 1/ - . . . " <br /> � . r /�� <br /> � � _ Ind3.cate lot size, nane of streets, <br /> ' � % � � • � ' � �Sndicate location znd width c: <br /> � . j �. . . • ' � alleys, locate nr000sed and all � <br /> . � ?•�j . � � ' . existing buildinqs, shosa distances <br /> _ . 1 '- `! to pzoperty lines, show distances <br /> � - betaeen buildings. <br /> � , <br /> Lot size x <br /> ..• ` . Lot area Sq. Ft. <br /> f. - � � - Sixe of 91dg. Sa. Ft. <br /> ' ; , • Number of Stories <br /> . : . j . Sasement <br /> r.. <br /> ,� _ .~ - . . Signed 8 � / � <br /> . ; �/ !� <br /> ' • . �i(JS'�L� 'i'�-�����1��� Por Owne�/�P�e <br /> c.�rvk F�� � <br /> DO NO: S�3ITL 36LOC7 THIS LINi-20it CI.Y USE O:IL'L <br /> Daie �eceived U=e 2one <br /> ' Plan Chec;; :7ur.Scr Fize 2one ' <br /> Valuation Occuoancy Grou� . <br /> Pemit Fee Type of Construction <br /> .- Plan Check Fee Occupant Load <br /> . ' tbtal Fee Due Sprinklers Required - _ <br /> Date issued � � ; , . - <br />