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<br /> _ . .. . • • : pE'yiAc,m� ♦u ia.:�ptecc 'a'taL� :orm / / ��' � : ;.�
<br /> . . � . . • ' . ., �p/J�j��� •.
<br /> , • ^ ' If oare than one buildinq is ta 6e contructed, submit a :eparate perr,iit ,.pplic,:-
<br /> . , $ion for cach buildi7tq. A s :psrate permit will bc issucd for cacli building.
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<br /> . " � Ovnet �.,.i-..-��%�'�%�-- Duilding Addsess ����J�� ( r �(„-.; ,
<br /> .� • � AddrCSs ��.,?G<? �i1;/s�,_ j7�. LOt ,7;-3a � 3� Hlock �' '
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<br /> . , �City r,�y,_,.�,<_�.5� Phone.3S""3- ia >�- Subdi43rion (Plat) G'L,vu�-� �<.,¢G=�: '
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<br />, : ' • iSrchiY.er.t/Engineer ' � ?�,- 4y_ <b' • _ �
<br /> _ 'z � . '_� �.ity • Phone Efetes & � a�ds (Unplatted) _
<br /> _ � ;,•. (�tractor i::Y�,.. -i. � Seo.� -- nrp"-_--- Rge . .
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<br /> a. :. . : lddzess ' __ ' . ,
<br /> I� . �� City Fhone I3uilding Use ,�t:..�.�'+ `"��_ ',�r� • ' ""��
<br /> _ � '`.' �� :•.�-':.:
<br /> '�� £tate,License tic�bcr `�•�3'-'��/>;�.�_ Describe Svork to Be Done ^�i�.���.�``�y` '~
<br /> : �i �iration Date ,}-/- /C � ' � •
<br /> a�" � ' • • SP.ETCH PLOT PL.•LN IIELO'4' • •
<br /> • � �--- '�— • . � Use of IIuilding ,r.r,.s�_�J%:��,..2:� •
<br /> . :.� . • .. - , ' , �— .
<br /> �� : � . , � , ' �tSew ❑ Iedditio❑ Q Repair/P,eno�el
<br /> . : ' . . ' . ��'' ' ' , t'
<br /> , `�;. . `���• , • Y7aluation of Construction $ ,�? pze• �
<br /> . . . � � =. � I . . . .
<br /> � • • . � . .•. { - P.iAT PLAY. R=QUI?LE:•Lr:ITS •
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<br /> � � : - ,_ _ , Li••'.' � . '
<br />. ` ` •�� - �� LjY,Yj ' Indicate lat eise, nzne of streets,
<br /> '. � • r ' •indicatc location and c:icth of �
<br /> � \,� �� i• = - .. _ '; -• •r;Y � - al ys, locatc �=oposed a::d all
<br /> - :' � u ' ' • . �•: ��j[��,i^..ting t,uildi.-.gs shc:v cistance�
<br /> � ' p4' _,. :�_. __ ,a . . '� _� s - y lines, ,shoeu distanees
<br /> . ; � ... � . . . ✓ . !i :��.d�Lu`.ldings. . . . .
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<br /> . _ .. � , . • , _ Lot size •�—x �O" 7 --
<br /> td��d-f •� i -- i�-- �� ._�_•—, _ . Lot azea �' �� 7 S � 5q. Ft.
<br /> G. ' _ . 1 . • ^uize of Eldq• �S ,� G > Sa. Ft.
<br /> . . �; � 2tumbcr of Stories (n-�
<br /> • ��j LG. �`' . ��j1. . . � IIasement �:-o
<br /> '�,r�' -- � - Q' r Signcd II:' ��..1._.-�a ��7�-f-_..
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<br /> . +�_ . .[�--..- _� 1� -_�f �Or
<br /> � � 7 5 Ch�ncr Yhone �S:'- y.��r ��
<br /> _ _._ , iCLE1 v� . ' . : .
<br /> .. ' � DO NOT S{3ITE TJ�LOPI THIS LZ:IE-POR CITY USP. Oi7L'l � .
<br /> Date received � �1.CF - i r IIce• Zone . �
<br /> ' Plan Chec;;, `7urSer !f� --� ������ ' Fire 2one 3 ' ,____
<br /> :'aluation '2 3 S Z�. �� Occ��oancy Grou� I
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<br /> Pcmit Fee ���� Type oE Co.�st=uction � -F•..f .
<br /> S'lan Chcck Fce ��F��p Occupant Lo�3 .
<br /> � �'otal Fec Due . �v�' Sprin}:lcrs It�i�SiYr@fl E`����ETT '
<br /> � � APPROVED FOR BUI�t� � '
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<br /> Date Is�ucd `�� . . �,. � �.R�:.
<br /> � • � � • • Dote•��°!-�=��—dy .
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