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, � . . .. ��y . _— <br /> BOILDING PERMIT APPLICATION � ,c <br /> -� ' , 1lpplicant To Complete This sorm / � � v/j� �, <br /> , • St swre than one buildin is to be contructed submit a e aratc `�/ ��s <br /> 4 , s p permit applica- <br /> . : tion for each building. .1 separate permit will be issued For each buildin�J. <br /> �;(� Ovner ��"� �-:u�� Duildinq Address y� �3 �/�� �i;,. . <br /> r t. ��:n . <br /> . �� ��- f <br /> , llddress y� /� �1t�1�.r.;n-6-M1 �� Lot Hlock - . <br /> City/ivLf,�� Phane _ Subdi4ision (Plat) . <br /> � • �chitect/Enqineer _ � <br /> `"� City Phorie rietes S IIounds (Unplatted) <br /> - _ "i <br /> ' :,� Contractor %,a7,�'�/i��r�.-���ir-R� Sec. 7Wp. Rqe .. <br /> r / <br /> .� . � � lldaress ��/G��/tr-s�xo��-y'�%7'�tf' � . . � . . <br /> ' City �I�_ Phone JJ Y "�T� � 1 lilding Use �,.�p_���f.c.,'.T� • _^� <br /> ^'� State License Number�_),J U! 7 !' 7 J Describe Work to Be Done ���,�¢, �� �y ,� ,�,�,r?�r <br /> . • �' �._� "' <br /> : 1 L:pization oate � - / G ' J E � di� / ^ ' <br /> � r- .�. ��� � �? ^.�!-�'''' <br /> �� ' � ' SICETCH PLOT PLAIr' IIF.LOW' • ��? r! �'7 rrr-t�� Ain -5. }f-��.7-T!"✓'Y�j� � <br /> . _ �` <br /> . • ' r . � / _"_� . <br /> � � � �- i_ -- - � �J Ose of Building �„4:y ��'�t�.f,o ' <br /> : I <br /> ► ,. . :� . . � ❑New � k•idition [�Repair/xemodel <br /> . . .. . ' ' �U d' r <br /> . .�,� � � Valuation of Construction $ <br /> e (� . <br /> -r•.- • . � \� • . � PLOT PTJ\N REQUIR&�fE;ITS <br /> .� . . \ . . . , . <br /> . � . • . <br /> . . ' � ' � • � - . IQdicate lot size, name of streets, <br /> � � �' ' ' � � �indicate loca:ion and width of <br /> ' • j � _� , . . • . alleys, locate nr000sed a.^.d all � . <br /> �� ' .'�.t � ' existing buildi.-,gs, shaa distances <br /> . � �� " '! . . � � to property lines, show distances <br /> . _'� �,�, ,{� �' • betaeen buildings. <br /> � � � . (J?`�.' � • ' <br /> � ;;;, _����.a+^� � Lot size x <br /> . <br /> (�m • i?�rrr�� � , • Lot area Sq. Ft. <br /> ��=: .� _ �p ,- Size of Bldg. Ea. Ft. <br /> � � � Numbet of s:.ozie5 — <br /> � ' •% 1 . Basement <br /> :.. <br /> / , <br /> ,� _ �. ?..Signed By �iA.,�A�i .y�;tir�-'��2-��: �(. <br /> ' � --- - — FoI <br /> Owner Phone <br /> � DO :10': Si:2IT: iJEL0I9 TI{IS LI:4E-FOR CiTY ilSi OiIL'L <br /> . Date Seceived �//(.�� U�e� 2on� - <br /> ' Plan Chcck :Iur..ber ----- -- � ' Fire .one ' <br /> Valua:ion i��'-'Ln `�' <br /> . Occunancy Grou� <br /> Pemit Pee �<�, �''�� Type of Construction <br /> Plan Check Fee Occupant Load <br /> . 1bta1 Fee �ue ��� F� � ' <br /> Sprinklers Required <br /> Datc Issued � CG'/(^�.%�,� • , � _ � _ <br />