|
. . , . . . _� ..___..,.._. ...;.�
<br />' " ' ' DOILDZNG PEAMIT APPLICATION � ' � � '��
<br />. ::
<br />' , , •1lpplicant To Complete This :arm • . �� � �
<br />' •. : �� - �;. .
<br />ZL more than one buildinq in to be contructed, submit a separate permit applic�jr^7�/ _
<br />tioa foz each 6uildin3. ��1 separate permit will be issued for each buildinq. �>
<br />„i , � .
<br />d
<br />�
<br />Ovner �;.�...�/ 1,� .(�,-.�,.1,:,; C���_�- nuilding Address .
<br />F % l.
<br />/ddress ��: �' �- r ,�, � Lot Block '
<br />City ti!..;.-<.I1� Phone Subdi4ision (Plat) •
<br />' - iTChitect/En ineer .f ' • •
<br />_ s ,�, %: „ ,(,;
<br />/ � ;-
<br />_ • `• � . .`.'i City ' , (�_Phone I4etes i Bounds (Unplatted)
<br />: :,' Contractor /�'r�; C.�,c- � ' Sec. SWrp. Rge . '
<br />: . � ]lodress 17't i�` �J '�.'/� �.�.�/%Ii ' '
<br />;, .
<br />- . ' �
<br />.. �' City _ Phone ;1: U--�� 2/. i`' Buiiding Use t;:. :_��...
<br />•;� ,•
<br />� �'�i � State.License N�aber
<br />: .•. 1 Lzpiratian Dat� _
<br />� 7; - i' f- i;"i � Describe Work to Be Dane . •`��•F Y
<br />��' ' � � SRETCH PLOT PLA.N BELOSP
<br />' '., i .' ,. .
<br />: .j . . • . .
<br />a� � .. . .
<br />. . . .; .
<br />;. . . .
<br />� ' � . . . � . . - �. •
<br />..,-' . "' ...
<br />+. � -
<br />� • f . . � . � � .
<br />." 3
<br />.� .
<br />, . I . " '
<br />3
<br />. . � ' • ' - � . '
<br />. � � y .
<br />. :: ' �
<br />:
<br />.�. � .
<br />.. . s
<br />• r. -
<br />�.;
<br />• • •! - 1
<br />}v:. _
<br />i
<br />• .
<br />Dse of Buildirig
<br />�New [� Addition Q Repair/Remo;:el
<br />'Valuation of Constructicn $ lL•t' CEr '
<br />. . PLOT PLAN REQUIRE}SENTS . , - .
<br />IDdicate lot size, nane of streets, �
<br />•indicate location and width o� _
<br />� alleys, locate nr000sed ar.d all " �
<br />existing buildings, sho:a distances
<br />to property lines, show distances
<br />betveen buildiags. �
<br />; • � Lot size x
<br />' • • , . bot azea Sq. Ft.
<br />Size of 81dg. Sa. Ft.
<br />• Number of Stories
<br />. • Basement
<br />, � /,
<br />� ! Signed By ,f i��.. �=r� C' �,���G
<br />For �` -
<br />i �. _,., ,. %-
<br />• Owner � Phone i�; �� � ti" ?�,�
<br />DO :IOT TCZrTc
<br />Date �eceived ���d�/�$l
<br />Plaa Checn :Jur.ber %S �3�0 /
<br />Yalua�ion /��i,�,�,�`J- � ��
<br />r
<br />Pemit Fee �'fi'�- uu
<br />Plan Check Fee � p(o S�
<br />ibtal Fee llue N7�� � �
<br />Datc Issucd �� �-`
<br />'�"1
<br />II�e Zone
<br />Fire Zone
<br />Occuoancy Crou�
<br />Rype of Construction ,�/ - � t�t(;.
<br />Occupant Load _
<br />SprinY.lers Re i �e,d � '
<br />. �Ifi, G; �_ ._,.._i
<br />• •APPR6V.4D FOi� �U�i.DIi:G f'ERMIT
<br />..Date_`��Lv�_`1i �y_�C , �,r
<br />� . ` .
<br />
|