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. � ' ' ' Drizr,ni�ac reru�trT nrrr,zcnTrota ' - . /• '�^ �._
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<br />' „ ,� ' � :' ,- Appll.cnnl To Co:nplelc Thi:; : orm '. � j/ �"�J�'���i
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<br />••� TP uor.c thin onc buil.dinq is to bc contrur.tcd, suhmit a c aratc o" '� j
<br />� %�
<br />•. t•lott for c,�ch buil�lir ' P l�crmiL- ap�lica
<br />. �• A sep�raCr permit will bc is�ucd f:or c::ch buiJ.Qii�g. .
<br />. ' trencr /> � '; , ,
<br />'•F L lluildinq Addxes� _',�,<j )/ i y�: i'
<br />. � •. . �]dresn ' j'/ 4 ('-; i • _ � LoL- (• ',� � Dlock /�
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<br />, CitY =, : T'- Phone Svbdivision (P1aL•) _ 1 i';� 1,,. c t` � .
<br />, . - .
<br />_ • Aschitect/Engii;eer � �
<br />�i', l _J.:, .. - .:
<br />_ ' :..I Cit �,.- . .
<br />- _ •=j Y Phonc _ .tS=tes L Lounds (Unplatted) .
<br />: ..:�•. Cmt•ractor S! i/�. .^,ec. q•�, r .
<br />_ . � r�e:,:�.. %� 3� � ; � • � .
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<br />. ?' ,City t�lc�.., ,�.,-c� .Phone 77l- /'� � 'Building Use %j,� } , ��s ri.eL � . . �..:' .
<br />_ ,.. . . � ..,� _:'.. .
<br />' � �; � � Stete iicense tJa:.her CL"> -„ / � �' f S-/ Describe ftorl; to I3e Done � � ' ���� �
<br />: . �i I�iration Dat� � . ', / / ,. �, , . .
<br />. �> : .. ' . S}•.�7'CII PliOP PLn? r � �. •
<br />_ . I ?2..LOFJ � -
<br />• . � ' .. .. . .
<br />. :.1 . . . ' . . ase of. nuildir.g . •
<br />_�' .. ' , " _ � : . • . �l c � .
<br />. , , . ' ❑ Addit-i.on ❑ Rcpair/Remo;:cl �
<br />• ! - � • . - - t*aluation oi Construction $ .' �,,.�.;,
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<br />~-:•. ; .. ' . . ' . ... . .' � . . iPTAT PI.A'.J P.;GUIF2L:!::7'PS . . . .
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<br />•_ ' •� �� . � � � ' ' � Indicatc lot ,ize, nane of. _. rcet^, �
<br />, i . �, .. � . ' ' � � ' � •indi.ca:c locetion -ar.d :.•id•�hro�
<br />. .�� - . . ' . �;� - ' _' � ' alJ.cys, •lo.^.atc aroposed a.-.d a17. � .
<br />•., . _ � • �exi�ting 5uildi.acs, she:,� di^.ances '
<br />. ,; ... � . �•° � .j� . . . �.L-u property lines, �I;ow dS.stancca
<br />' ' ; � � ' bet�aecn buildings.
<br />• . . � . � . ; . . . .�Lot size. S-�� x / Z��, .
<br />.. . � .
<br />� - ' � � • � T,ot area � Sq. rL.
<br />. � � •:• ' ' ' ' . �S12C O£ ?'i1Cg • Sa. Ft.
<br />• ' 11U711�>C: O: tilUY.145
<br />� �� -� � • ' � Basc�ent
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<br />�� _ � �. . � � , , Signcd IIp�% � � a���'o�>-c��.'-G�-�.
<br />' ' . ' E•or L �� --/Z ,j �, .
<br />" � � - . ' Ocancr Pl�onc �
<br />PO ::0: {iZ?iL 9-:.0!: TI1I.", 7.L?li:-FOR Ci9'Y it$r p:iT.'L - � .
<br />_ Date Seccived � � Uce�.^.onc
<br />' Plan C:icc;: ::w;bcr ' ' Firc 7.oac . - —A..
<br />Ca:uation �
<br />7�emiL Fcc �
<br />Plan Chec1; 1'cc
<br />i�:C.11 I�l'C Due
<br />t>: te :[: ; uc�l
<br />Occup:u�cy Gr.ou�
<br />7y�;c �� Cora:truction
<br />OcCu��a.nt I�oad
<br />Sprir.!:lcra P.��quirod
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