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- - '3 <br />:� <br />r <br />41 <br />�i <br />� _ :i <br />.�: .. <br />" , 'I <br />; '1 <br />� <br />• <br />� �. <br />. <br />� - � DOILDINC PEAMIT APPLICATION �. � C.�� Q ' ,C..j <br />� �pplicant To Complete This ?orm / � � <br />. �/��� <br />I! more thar. one building in to be contructed, submit a sepazate permit applica- <br />tion Lor each building. .l separatr. permit will be issued far cach building. <br />Ovner ��� �u��>.`l, 8uilding Address � i::! 'J � `,.ii,.;: . ` : <br />iddresa 5 v� nr,� o� Lot i' d� Block '!% ' <br />i • <br />City � v% Phone Scbdivision (Plat) • - - <br />�rehitect/Enqineer � ', i !:��� �,-j ; e• ����, • <br />� <br />City Phone _ [Setes a nounds (Unplatted) � <br />Oontractor �/���f cY % �'i:'<% '� Sec. itap. Rge . <br />/ <br />lddress � J �ls'�ry ,-�c)/. � . . � <br />� <br />City ��;i; � Phane �S'l�-�/,5 % Buildinq Use y�,.,���: ��•;:��_ <br />State.License Number ,^.:3-�'� //-;��-J peacrihe Work to Be Done i� i'i '.��`��. <br />� <br />Lipiration Dat� � / —/7- i' `— � ' /��PG / y � <br />- � <br />� SICETCH PLOT PLAN BELOW � • � <br />� 1 � <br />Ose of Building /f,�i . <br />❑Nev ❑ Addition �IRepair/RemoGel <br />Valuatioa of Construction $ j' J J�'• ��� <br />. . YLOT PLAN REQUIREbiENTS _ <br />� Iadicate lot size, nane of streets, <br />�indicate location and width of <br />� illeys, locate or000sen and all - <br />lxisting buildinqs, shnw distances <br />to property lines, shoG distances <br />betaeen buildings. <br />bot size x <br />I.ot area Sq. Ft. <br />Size of Sldg. � Sa. Ftl <br />Number of tories ,I <br />Basement � ;I � II <br />I I� <br />Signed �By - � � ;-n, � ,J1���' � :A , � ���� �'� <br />For <br />DO NOT StiZITL 8'cLOF7 THIS LI:4E-FOR CITY USS <br />Date �eceived �I �il % j � <br />Plan Check :7ur.,Ser '�— <br />7 ���i-U , e U <br />Valuation <br />� �I pc_ <br />Pexnit Fee �r-y-� ` <br />Plan Check Fee <br />n� CG <br />ibtal Fee Due �i-v- �' <br />Date Issued <br />D:e 2ono <br />Firr. Zonc <br />Occuoancy Grou� <br />Type of Construction <br />Occcpant Load <br />Sprinklers Required <br />. ; <br />0 <br />c <br />