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_ • . � ' � � ' DOIL�ING PERMIT APPLICATION . • �� ? <br />: : Applicant To Complete This : orm ' / �� .�� <br />, •' If mc�re than one buildinq in to be contrueted, submit a separate permit applica��9��j <br />tion for each buildinq. il separate permit will be issued for each building. <br />�(� ,� <br />' ' Ovnec � 1A�-��� U� CJ ij'l +� '�,., p � _ Buildinq Address .1 !=> D�� � : <br />� [� <br />, iddre�s'� _'� p 3-- 5�� �- � t-c� Lot �• Bloc`� CU � L IJ �-c��� L <br />Clty �='J�-(Lt� i C-Phone��-'S� -U',<<s~{� Subdivision (Plat) `��-.lQ c. ��. V�rL- <br />' • lrchitect/Engineer � ___ _ ' <br />•j� '"� CitY _ Phone Metes i Bounds (Unplatted) <br />. �i .. <br />:� Contractor Tv D� f\ �Cno o� Lv N� � ��'�-Sec. Twp. Rge � <br />�' <br />� ]lddress �� 2 - � '� ' l t',1a � � t- . _ � , <br />(�,� _ � <br />' City "� ��� l-L- Phone Z � C� - 3 -C( � Build3ng Use ` : ,: -`�';.,; <br />{� State License Number ? Z�^n ��� 7y%�Describe Work to Be Done .'" . <br />Y <br />• .;i L:piration DatE / � � <br />:�' " � SRETCH PLOT PLAN BELOT9' ' � <br />• i ' . Dse of Building � <br />� � { I ,n , ' � L�New [� Ad3ition ❑ Reyo�,./Remouel <br />. 1' ^i'�� \ L.• \ b � • �'�-C C• •' . <br />' � ' Valuation uf Construction $, J G�� <br />•� -� �z �3�2va�� �� <br />� <br />' <br />� � � ��4 . : <br />. <br />• ; . . ' . . <br />' .j � . � . <br />. ! . � . . <br />:.r� , � . . . . r- ,v • . . . . .. _ . <br />� y ' - <br />DO I:OT S�ZIT� <br />u^ate ISeceived `-+� <br />Plan Chec� :Jur.,ber �%S -��j (;� <br />Valua� t i on <br />� JC�t�� - 6 t'� <br />Petn#t Fee � Z-- � �� <br />Plan Check Fee <br />' � ` Jz> <br />ibWl Fee Gue <br />Date Issucd _ �-�(�I7�_ <br />P7,OT PLAN REQUIREBSENTS . <br />Iadicate lot size, nane of streets, <br />indicate location and width of <br />alleys, locate pr000sed ar.d all <br />existing buildings, shotu distances <br />to property lines, show distances <br />between buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number f Stories <br />Hasemen <br />Signed By C�. �-�--� <br />For <br />Owner Phone � <br />CITY USF. <br />Ace Zo:�E��_-XLC'✓�L�'dti ��� <br />Fire Zonc ��,�' ' <br />Occuoancy Grou� J _ <br />3'ype of Construction ,� ti( <br />Occupant Load � �� <br />Sprinklers Required <br />" ' . CITY 0� E�LERETT <br />� APPROVED �OR f3UILDING PERMIT . <br />• r <br />i�te �--��t/_��-_ 6, ��—.� • , <br />