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<br />" • , � � .. , ,. . • • - SOILDINC PEtiMIT 7:P?Lli 1TION � . ..? � �� , , . • . :.�� .
<br />_ •• • ,Applicant• To Completc Tl�is :orm „c�� � '. . j�� •r
<br />.. . i . • • . • " ' '.. , "1/�/�i:
<br />, . I.i c.ore than one buildinq is to be co�itr.ucted, submit: a�eparate permit applica-
<br />,. tioa fot each buil�i:i�. .l cep�rate permil will be issued foc �acl� l�u;lding,
<br />/� ' �i
<br />' • a.'neL �^i� r� �� ... /R��'-:c' f o r' % BIIildiny nddress � ' � r� 7E,x �c'.,- .U,. :
<br />. �
<br />' • � R�ddress .2 �{�!U %c: •• /c> �• �r Lot fl i ,a L �T j Elock :� ' _ .
<br />' . ' i .
<br />City � t�;, rz j f Phonc ,3�->'JC- /C Sub3ibision (:lat) �•
<br />� ' • ATehiteet/En9ineer ou,.�c,.- _ � '.r•.� ,�_, ��i_/ � ' ,' ' •
<br />•: �`'� City • Phone Metes 6 T3ounds (UaplatteC) •
<br />- ' . f '/ _
<br />;�•: Contractor �7�t/ (� �,,. sr � � Sec. m.�. � Rgc ,
<br />. • ,. � .
<br />_. ;. . � a�ar�5s -�Isy.zi - ia�.l s�r. s� � . .
<br />.. ?: City L'F; rcr7i Phane .3jY 36 �,.? Building Use /'i`:•w vw � ��i::� t .
<br />�ii .,: � � ' , �•,
<br />� � 5tatc Licensc Ni:nber ���-j- �' �-�.% �% %� DescriUe Work to IIe Done � �'' .
<br />•��
<br />• ,�i EYPiration nata �I= vZ- I- 7 7 c AS: !<<' .s n.�. �i cb �_.-,.e a p .
<br />��' '� � ' SF.ETCFi PLOT PLi+!: IIELOI4' • • � � dr � � � �^ -- _
<br />. .. � , • .. . . • S1se of IIuildidg S �u �++qD � ��'�•. •.�, •
<br />• . � , . ' • . . - � ,..�
<br />�. ' - • ' , ' ' , , . " � Qt7ew ,� I+ddition `�Renair/Remo�cl
<br />� " �'�. � � _ � . � • � � . � . �� • 'Valuation of Con�truction $ /n oo ��. .
<br />. �s� .. . .. . .�� • .. � � � _� I . � .
<br />•�...- . - � .:. � .. -. � • . . f'7AT FI.71?] A.FQUIZF'�L:7TS � . .
<br />y . . . . • I �
<br />� , . . .
<br />• -a . . • - . � . • � . • ' ZAclicate lot .ize, nane of ..,.reets,
<br />•. - ' i � . � � . ' � •� •indicaCc locac:ion an� wic'th'oE � . �
<br />. � �� � - " i'. ' _. �.. _ � ' tnlleya, locate nroposed acd all �
<br />. � . .: . - � • . . er,i.cting bcildi:;gs sho�.a distances �
<br />� � � , �-• •.'- -- r ' . � .:':� - . . t0 ptoperty li:ics. Ishow distances
<br />' ! � • - betwecn buildi�igs. •
<br />; • � . _. , . . . .
<br />� . .
<br />- . .�. . . : - . I.o@ size :: ' .
<br />� � 7.i: c . . . � • . . Lot azca � Sq. Pt.
<br />� , r �i , , - . � � � . Sizc of HlZy. _ 5a. Ft. �
<br />� � e-j � - � • � . � � t7ur,�uer o£ Sturi�' _
<br />• :: . i . . • Itasenent � -
<br />� w'.. _
<br />°� •-;' � • . . _ � � Signed IIy � ', ��rL��c .
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<br />, �_ . . � r•o: , �.�„ 7.
<br />. � _ . . . . ' � Qwnqr , toae 3>9 � iG 's�_
<br />' � DO N(�T SdZYir 3=L(11�7 THIS LI\E-2CR CITY VS� Gi7L'I � �
<br />. � `,
<br />Date received �-'(� ��71,.� IIcc Zone � S �=/�l��,���..T�
<br />_ --r—r
<br />' Plan Check :n3r.,Ser % t@ `�4S � Fire Zone _ ���
<br />�'aIua:ion � L� C�C`X_)� ���"� Occupaacy Group �_
<br />. . . . • dU .
<br />pemit Pcc SZ..' Typc c,f Con�L-ruction .J� i._j____
<br />Plan Chccl: Pcc �(c_� __� 6::cupant. Load
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<br />� Sbtal Pcc Duc % �- __ 5prinYlcr� Requircd � ^ .
<br />' .. • . �CITY n- ; �,��:.;�EiT
<br />Daco Issuoa __.__— , APPRQV�U. ' i
<br />• < . .. fC!ii ;�UiL{;IT�G• P[RMIP .
<br />.. . �at�--.�!_, � -- t?v-�r.. � � ' '
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