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<br />� • " . ' DOILOZtiG PEFtHIT nPPLTCATION . , : , .' "•, • • •j •� j
<br />• .. • Applicant To Completc Thi� :orm y��,//��y .�
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<br />If narc than onc building is to bc contructt:d,•submit a separatc permit applica-
<br />tion far each buildin3. .1 sepazate permit will be issued for each building.
<br />� _ ` � -.: �?�,,.I�� E_ ,%�;. I
<br />trmer i,' i !' i,� � ( : _ Yiuiluinq Address �✓ / -f "J.� �
<br />S+Ldress � `% (i i / ^ G /�/. �, r..- Lot � � � Block >' -
<br />City N/K/j�? f, i��% 'Piione �,, _ � . : - � � Sub3ivisior. (Plat) . .%Sr �'���.� �%�%i%
<br />Erchitect/Engineer _ �` � �
<br />' ''i City <' Phune � " Hetes 6 IIounds (Unplatted) � '
<br />' "i • ..
<br />: �.,� contractor I.' i f 6C' c' i!r sec. 3 1t:-p. x S aqe �/ .
<br />, .., . _
<br />- , .'' .i�ress _: % i' / /✓ C' i-'/ /l �' • . �
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<br />,. ! ,City �/i�,'Ci ;, i : : c!(.� Phone ii-.i^ %- �J C� �. 'Etuilding Qse •i �= S / /� := . �, -� . ;:.d ''-
<br />" �'';'� � Stzte,License NL:..ber 1' /,Y�•���:5�`!�� Describe WorY, to IIe.Dor.� .� J
<br />• . �1 i�Piration Dat� � - ' C, - ; �• � !' 'i' _ ' � � ' - - �,
<br />��' : i � _ - - 'SRGTCIi PLOT PL:L'7 BELOS•7']��J��,tj -- . • '
<br />. . � , nL �.' w J , . � � IIse of Uuilding _ °_,. , =. -
<br />. . . :.1 3;'' � .. � .
<br />.��"" �. - - '(,�r 14�H � Additi.on ❑ Repair/�eno_el
<br />�� : '� . . :_. . : .
<br />. ., . ' - �j % . . •. • : `��a
<br />• P . I �% '. Val.uation of Const_uction S� �, �- ��'
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<br />', �o _ .�— '_� - . i1'UJT PIAN ILQUT^�:�+.-uz�s - .
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<br />, . L�; : ___ •� . zndicatc iot Li.ze, na.:.e of streets,
<br />• � � . � £� - •indicate loca�:on ar.d wid':h of
<br />, j '�_�`f • allcys, 'locate proposed z.-.d all
<br />' • • �" "� � - • .existi.ng buildi: gs, sno:a �_�taaces
<br />� ;�;i - � ..: _ . : : :: i�,: � . . � c
<br />-_.� �i �: -io propertp lines, show dis;;arces
<br />^ '; . • • • `�. - _..betti�ecn buildings.
<br />� . � ` . � ti. 4 . � � � - � • .,-. / � ( ; . �
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<br />; . � i i ' s, !. i (�1 ��� l��'� :�
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<br />h/� , Signed IIy �i/i�?i /i; ��, ' ._ i, c
<br />For�l.c�;�_ (c .
<br />, • Ocaiicr Yhone _ c <� . -� .- �; ��
<br />j�pt S1ZC
<br />I�t- area
<br />Size of D
<br />Nmabez of
<br />IIasenent
<br />X �
<br />; .'i 7 SQ. Ft.
<br />/�,Ys- Sa. E•'t.
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<br />DO NO':' S•:.^•.T_Ti 9iL0?9 THIS LI;dE-FOi: C.'TY llS£ O'7i:i ---- .�
<br />Date Se�:e::vc2 _���5. Uc�• : ,,: r:' ----•--- ----_..._....�...
<br />!'laa C:�ec� ::u:.bc� �iS- �d ' Fi.r� Zonc _ �
<br />t'alu:.�ion � �`-=� �v�3- �� Occuuancy Group �
<br />Fc_�iL•' Fcc �SG�`7. �U _ Typc of ConstrucLior� � h� .
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<br />:lnn Chctcl: I'�c i 2, S� � OccuPan� I.�i.l __
<br />�;i'ota.l Pec nuc 2�� �ZJ -- �Pr.inlcl(�r� n�'�1N=�r• �vE�;��Tl �__
<br />, � . A�'FROV[D FOR BUILDING PERMIT
<br />ra;e Tc�::uca � ?�4-� . . . .. /_ . . , _
<br />' . . Date, `��.�8�� .I_l . gy ' �'.,-�---
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