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.. <br />• � - � 80ZLDING FERMIT APPLICATION � � .j:j <br />_' • l�pplicant To Complete This ?orm � <br />• If more than one huilding is to be conCructed, sn6mit a separate permit applica- <br />. tion for each buildinq. A separate permit will b� issued Eor each buildinq. <br />% r / ' �fS;�, <br />' ' Ovner �, P i �L�; �'��� �-� � Hnilding Address ,�,5 ! 7 -� .� � <br />. - i <br />. ]Iddress �,S'�i I - �� / �� 57" Lot � -1,'1 / �� Block f (� ' <br />l' <br />:..� <br />- - "i <br />• � <br />! <br />:.; <br />:i <br />, ..' I <br />:� ' <br />• ; i <br />:1 <br />! . <br />O <br />-.... - , <br />: <br />Clty <br />Azchitect/Enqineer <br />Phone <br />City Phone <br />Contractor �Q �n,;��,,, ro i e �• ' � <br />,� J 5 J .. . ; <br />Subdivision (Plat) • <br />� <br />% ' ,� , - � c�`c � �`�'�`<��-lU�.. <br />..l , _ <br />Metes s Bounds (Unplatted) <br />Sec. 2t+p. . Rge <br />� <br />]ddress � 1 1 � � <br />L���i S/_ S ��. ! � <br />City 5,1 Phone LBuildinq Use /\� �. �.�= � '';-�". <br />State License Nuaber .,? �- �i - �' � - �� � �� �� Describe Work to Be Done `� • ` �� <br />Ezpiration DatE ��-�t' � . <br />� , _ �� i <br />� SRE1'CH PLOT PLr1N BELO[9� • '`^'`. t`� `.` - ` ���� - <br />(l f � 4^� � � IIse of Building � <br />�"�. �, V l i 3�.z . . <br />�- r . <br />r �/ ����,� . / <br />, ; (lL�'-C/Iit�..Cf �l•�w`'a� <br />_ .. � 1 L� <br />�:� ��C-� L':i �L .�. ''. <br />� <br />, . . � ❑New ❑ Addition ,Q Repair/Re�no::el <br />� ;: <br />• 'Valuation of Construction $ �'�11� - <br />. � . PIAT PLAN REQUIRE"1E?]TS .. <br />Indicate lot size, name of streets, <br />3ndicate location ar.d widch of <br />, alleys, locate aroposed ar.d all - <br />existing buildi :gs, sno:a distances <br />. to property l�nes, show distances <br />• between buildings. <br />I,ot size x <br />Lot area Sq. Ft. <br />Size of Bldg. Sa. Ft. <br />Number of Staries <br />Basement <br />� �I + ' <br />Signed By ` v_r ,�i �i_ ,% 1 G iF ;��i r��_ <br />For /,' � . <br />/ �. � 1.��/iq / '� l � C -i-�_o �. <br />�� Owner� Phone .;l �.> - c-'� ; 2�. <br />i , <br />' DO :�OP Sti:iT_T.0 BELOt4 THIS LI:7E-20Z CI;Y ilSc 021L'L <br />Date S�cciced U:.e-Zone .. <br />Plan C:teck :Jur.,Ser <br />Valuation <br />Pemit Fee <br />Plan Check Fee <br />, ,� Total Fee Due _ <br />Datc Issued � <br />W <br />Fire Zanc <br />Occunancy Grou� _ <br />Type of Construction <br />Occupant Load <br />Sprinklers Required _ <br />• • . . . <br />