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<br />- ; • ,,_, �,j' Applicant To Corplete This =orm_ �•' > ��i �� •. ,•;
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<br />, �•, i.'. moPe hhan one buildinq is to be coci' ructed, �ubmit s separate permit applica-
<br />.: tion for each huildin3. A separate:�p mit will be issued for eac'r� building.
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<br />. �� 6mer C� C 0. I�. ��'li�`EU�<, l, �. ,'t.- ' Buildinq Address �7' 0 S cS ��Y_D -
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<br />� ' . „ �ddress ,�3 0 �, S' Z nt t� Lot � elocx '
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<br />, '�tY t=�'��-��`'-7`7 Phonc3 S3 � ��� � Subdi4ision (Plat) -
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<br />_� ltehltect/Engineer i���F W �', �. l. • �-o w c� � l. (/1�1z W�� d"7` g. '.
<br />_ ' ; � °`� City • Phone Hetes � Hounds (Unplatted) ' �
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<br />;,•; Contzactor � � N l, Icir'�. L� 1� �� Sec. n.rp, 8ge .-
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<br />.., .'f City Cii ��o:� J S PLone i�h 3'�(- e/� Bnilding use � r S` t�-E ti�T� a L,; _� '„
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<br />� SWte iicense Nuaber o�-a3 U� .(� �j70 �scribe Work to Be.Done '•�''�.�'
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<br />: : i Ezpiration Date � - � -7 � _ • ' /�d��Tl O �\I . B Fd t;a o ��� � .
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<br />� L� �' � � • SAF.TCH PLOT PL:+.N B�LOS9' • �' ��"'`lv �'°'� �- �<i "T��j7r'-�/ '
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<br />Ose of Buildir.g '� S� I C�V c'� 1�
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<br />' �; • � ' " . � . ; • Valuation of Construction S/O, 0 �L p a � '
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<br />` , .. : .�. _ •, . �. . , . - ^ _ PLOT F'LAN REQUIRE�L;ITS . .
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<br />Date S�ceived //� 0 �7 1 � �
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<br />Plan Chec;:.:lunber %S-q-��j '
<br />Valuation l�,F��� �-C
<br />Pemit Fee �Z - Q�'-'
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<br />•Plan Check Fee 2 �r' -
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<br />ibtal Fee Due % (SS - _
<br />Date Issucd ' :_ '
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<br />' 2i�dicate lot size, nane of streets�,
<br />-indicate location aad width o� ,
<br />• alleys, locate pr000sed ar.d all
<br />• existing bnildiags, sho:a distances
<br />to property lines, show distances
<br />betWeen buildings. .
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<br />3 c yot size x' .' .
<br />:Lot area � Sq. Ft.
<br />Sizc of B18g. Sa. Ft.
<br />Number of Storie
<br />Hasement %
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<br />Signed By � -'--�� .
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<br />Owner Phone
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<br />Fire Zone :i '
<br />Occuoancy Gzomz L
<br />Type oE Construction _� - ��_
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<br />Sprinkler; Required ' �
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