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• . ,_L <br />. . . . . • �t <br />. - I - + - � � ' B02LDING PERHIT APPLICATION , -�-•� �.� �j�•'�� ' <br />.- . • • 1lpplie.�nt To Comolete This =orm <br />. y <br />•� -If more than one buildinq is to be contructed, submit a separate permit applica- <br />� ., tlon for each building. A separate permit will be issued ior each build_ng. / <br />. • Wner - X ��r � ° • � �''` `:'� � r� Buildinq Addte :s `7 > z � • , i� � � n�c( ; 7 `�. - <br />' I�-ess ti i: i �i c; c�Jci /a'L�i - Lot /`� 81ock �- . <br />. • City Phone . Subdivision (Plat) (�1,«'r�cf/�e' I/�% K� <br />�- <br />' � �schitect/Engineer ; - � _ � I I� C� C` '.' �l� �" �'<' " � � <br />`"� Cityj � Phone Hetes 6 Bounds (Unplatted) <br />- i � . <br />� Contractor �.__ !', �c-i. �nl/ (-s-.�'G�.�Sec. �+P• R4e <br />. :, . <br />c. . , Mdzess �- �i��� � �- � � �� L �-� . . <br />- - � <br />i eity C-v,l�1 ..,: �:� C� Phone I I�" ���`% 8uildinq Use '•: ,`g, ,. <br />:,� . ., , . •.;�_:: <br />�- � ��rf � State,License t]umber )=-� C� 1� �i<'^ � Describe Work to Be Done <br />, .. ,. � � / _ . <br />. ;� L�iration Dat� �•�' l�' ' `� '� <br />�, <br />• . • � � . � � '� . q, {. . - <br />�� ' - � � SI�TCH PLOT PI.71N HELOW � • _ <br />. . . � . • • , � - ' <br />..� ' . .. IIse oP Building <br />, � � . ' � '��:_'� ��New ❑ Addition ❑ Repair/Remouel <br />, � � `N . <br />'� Valuation of Construction $ `� S� �' <br />, . . . �� � �� J / . <br />�' � YLOT PLAN REQUI?2&;IE;1TS S �=-;" `: �- <br />-r.. - <br />� <br />' . : <br />i <br />:�� <br />. . ; <br />'�1 � . . <br />: �a� � . : � '� �3 <br />Indicate lot size, nar.;e of streets, <br />..J �indicate location and width of <br />�, .' l�r�-{�� ' �-�1�� � alleys, locate pr000sed and all - <br />�) .� . existing buildi: os, shota distances <br />'•� <br />- - •. � � . � . ' . �. to property lines, show distances <br />1 <br />� ^� <br />� <br />r.. ' <br />•1 .. . �� r i / f <br />,��(`� 1 <br />• between buildings. <br />�'c , > <br />� Lot size x _ <br />' . Lor area Sq. Ft. <br />•' � Size of Bldg. Sq. Ft. <br />tiumber of Stories <br />�'� � Basement <br />l•-� �� J P �/ �1 <br />L r L�c'D � S;gned By /`J ��t y ��r:.L�C.'= <br />� For �� ��'�ii � , �/ ��+ 4� <br />� ._� <br />TOWncr � P o A �-+� ,. / }. <br />� DO NOT i<:tITB 9ELOt7 THIS LI:7E-FOR CITY USc 027LY <br />Date �eceived _ Use Zone � <br />� � Fize 2one � � �' <br />Plan•Cyeck :7ur.�Ser . <br />Valuation - Occupancy Group _,���_��75 <br />pcmit Fee 2`ype of constructiClTY-19f—f'���— <br />Plan Check Fee Occupant Load ���e6�inn I10--111. <br />Total Fec Due Sprinklers Required <br />Datc issued . • � . • .' <br />