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<br />._� � � � SOILDING PERMIT APPLICATZON � � • '-��
<br />'„ , � , Applicant To Comple;.e This : orm '� 1�t
<br />. . ,
<br />• If more than one building is to be contructed, submit a separate permit applica- ,
<br />tion for each building. �1 separate permit will be issued for each building.
<br />�r, � ,� �
<br />� �. � Ovner ��i� � � � ,� �' l' -� �_ , ,
<br />- � � 9 Buildinq Address � S�i 7 _ L� � �- �; ,- '
<br />llddress v-� �j�� � ' �-1 / "'` 1
<br />c -
<br />,_ �t % 1" ! Block C' / O - Q - c, ._ .
<br />City G t,� . Phone ,.� �'J -/. L� �I SubdiLision (Plat)
<br />1lrchitect/Engineer � � � �� /J� ^
<br />c`=c _ � ,.�(i � � � o-/- / q ')
<br />�r"(i � �,- c � ( r Gk ol . -
<br />City Phone Metes sJHounds (Unplatted)
<br />:, Contractor � � � --
<br />,sin 3J'��-�� Sec. 7tJp. Rge
<br />• ' 2ddress �� /7 � �� ^ �! . .
<br />:% � �
<br />�tY /ltJ Phone�];,2 5:��-2- Suilding Use ,�_�.� �
<br />:.i :j•
<br />� �;; � State License Nc�aher ���j --p/_�JUG c Describe Work to Be Done _�� ;.; �� .. �����
<br />�] � .�5�1 a
<br />, �f Expiration Dat� _ � �)�Ci'.."�Z' �7 ,(�,�y v��J � �
<br />i -
<br />��' � � SICETC}I PLOT PI.AN BELOW' -
<br />; • j _._ . . ___.
<br />� n . 1 ./� IIse of Building
<br />� : 1 ' . � �7�. �U.�t,rn•,.�.,'I.�c� .
<br />�-"' � L- XJ � ❑New ❑ Addition .
<br />` �j �Repair/Remo::el
<br />� l - ', /!1-ccX.�i�o. . .
<br />� ' � - �qv�� � ,5-�,i,o�.p,�.3�-+�-<X-e�� ,'t�alnation of Construction $ � v-�) �) �'
<br />. i�•,A,,,.zk. .
<br />. . ' ��Z CDK f�' �� fi.�.t�k< . .
<br />- / x li c:,� �R-.=� y��E.;.� . Ipdicate lot size, name of streets,
<br />.. "''P'�'i�S`�'_E�Ci'� �f, �indicate location and width o�
<br />' j . - . . alle s
<br />�,2�e�/- ������ � I y, locate propesed a,^.d all
<br />I .. � exi�ting buildi:as, sk�ow distances
<br />- � � -� �x' �Z°�"''= ' �, to property lines, show distances
<br />� 4 e u"^�� ; �c, betWeen buildin s.
<br />'k���5 _ � 4
<br />, . I.ot size i C-� x /O O
<br />.- -6- ` , . Lot area Sq. Ft.
<br />,� ••� ,—� , ' Size of Bldg. Sa. Ft.
<br />•6 �' ' o•�- ' ' Number of stories
<br />',-., " ' '- �" =-i--�-a � • Basement _ .
<br />__ - i - a-r - �
<br />� � = � � Signed By � ��. �+Z� ��-( e-t�� 4�-c�`J
<br />��:
<br />/
<br />� ' . � For � i
<br />� -�� Owncr Phone
<br />' � j� U -. .__._.. __. .. _. .
<br />� DO :IOT {'.:2IT5 B=LOt! THIj LI:IE-cOR CITY US'n Oi7L'L
<br />Date Seceived Uce Zon�
<br />PIAT PLAN REQUI4E�SENTS
<br />.. ' ;
<br />Plan Chec;: :Jur..Ser
<br />Valuation
<br />Pemit Fee
<br />Plan Check Fee
<br />. � Total Fee Due
<br />Date Issued
<br />Fire Zonc
<br />Occuoancy Croup
<br />Type of Construction
<br />Occupant Load
<br />Sprinklers Required
<br />. ..
<br />0
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