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— �, . � � . � ' � � D6IL�ING PEFtMIP AYPLICRTION . .. � ... ., _�v�.:. — <br /> - „ , ' , � . . • � llpplicant To Completc This Sorm � ' �� ' / ,� ���� <br /> , • � 2P ¢ore than one buildinq is to be contructed, submit a separate permit appii����- <br /> . . 41on for each bui.lding. .1 separate permit will bc issucd for each buiiding. <br /> • ; ' Ovner , „ '4 . . <br /> Sttildinq Addzes., � G�p S y*] �� 5 /� � I <br /> , � � . lddress Lf-0 f'/ t-f , �h ✓ fi �t Hlock . I <br /> , City ��2 H� j�" phone Z 5 Z $26� Subdi4ision (Plat) ; <br /> . ----_ <br /> _ � • Isrchitect/Enginee= • <br /> • :, ' `.'� CitY • Phone . � � . <br /> ' - , "j Metes L IIounds (Unplatted) 31'Z�( - r_�; <br /> _ ;,�; Contractor _ ,j�.�� � ' Sec. 3 � Twp, 2 ;� R4e O <br /> _ : ...� , �. <br /> - • � I <br /> _ � ' ;' ',' I,ddress _ ' • . � , . I <br /> • �: �tY Yhone Duilding Use , / n ' � <br /> �ii � _�.LcY /Ybd/�' � _-_'.- <br /> .. ••'�•�' . -:;.. ^ ..- <br /> � � �;j � State.Licensc Na�aber Describe Work to Be Done ' �. l � <br /> - • . f'AR�r� TIe;����:. <br /> : �1 Ezpiration Dat� ' _ U/ ,R LL ' / y� c_ n � 5 %` / ��g ' <br /> : �_ <br /> �� � �� ' SRETCF; PLOT PI..1*I BELOW' • rQ !P d �Q <br /> I . .. ' <br /> : •. ' .. . e . � : <br /> . ;q • . Use of Bui.lding _ • <br /> _ . . , J <br /> � � . � - - •.. ' �New ❑ Iv]dition ❑ Repair/Remo::el � <br /> • . : • , : <br /> ~ ! - ' ' • • ' • llaluation of Construction $ <br /> 'e . . � . . .�. . . . •. . j . . --- � . <br /> ••• . - . . Pi..L�T PLAN P5QUT2E}L.lT5 <br /> �d _ _ � . i <br /> q • ' . . . • . .. • O . . . . . . <br /> � . . • - . . . %ndicate lot size, n�^�e of �t� eets, . <br /> •i . . _ <br /> , .' � . _ ._ . ' •�.ndicatc location and �,•idth'of � <br /> ' . ' ' allev;, )_ocatc propo�ed ard all <br /> . ;.- . . . <br /> �',i ' _ :_ q : - . ' existing buildiags; shc:u distances <br /> -_ ; , • . • � • - • . to pzoperty lines, show distances <br /> • ; � 7. . � . y ' . between buildings. <br /> , ' . e a ' . � � . ' . � ' TiUt S1ZC X • � �' <br /> ..-.: = . . • . ,.. . Lot area ' Sq. Yt. , <br /> i.� r. . . Sizc of Blc4• Sq. I't. <br /> , • • ' Numbcr of Stories <br /> ' -! • i ' . Basemeat <br /> d.. . . • ' _ . . . <br /> .� - Siqned By c:I� <br /> � ;; . „ ,_ <br /> . _ . For <br /> ' - , ' Qwner Phone _ <br /> . �• DO ;10. SCZ?TL' H£LO[9 THIS LI:JE-POR CIT`_' USr OiIL7 ` <br /> Datc �eccived � � � <br /> . _ - l S II�e• Zone <br /> ' Plan C:�eck ;]ur;Ser Fire Zune � � <br /> Valua�ion Occunancy Grou� � <br /> Pemit ree '�i �V - . <br /> . . Type of Construction <br /> Plan Check Fce _ Occupant Load • <br /> . : ToCal Pee Due �j�� �G � Sprinklcr:: Required ' � . <br /> Datc Issucd • • " . <br /> • . -- . .. • . - <br /> . � . . . • <br /> i <br />