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' - HUILDZNG PERMIT APPLICATION /� ',;,i
<br /> � Applicant To Complete This ?orm ' ��7 5
<br /> If more than one building is to be contructed, submit a se arate �/�/��
<br /> p permit applica-
<br /> tion for each buildinq. A separate permit will be issued tor each building.
<br /> � Ovner ��r� �- �/�•.��r�> Building Address �/u/, '��=� �
<br /> �t� '
<br /> � . llddress /�irsC'�i �� - �/���; � Lot- - ����'ki�ock �'�Y'� �� �
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<br /> - _ _ --_ _, _<. .. . .� � � _
<br /> City /'i��;::�,}� _ Phone �>S.� / J� . gubdivision (Plat] �5,'�,7,�„ »,; i-,�:.,,�
<br /> � �� ]lrchitect/Engineer �/�/�. � - �;���� ,— .
<br /> "� City Phone Metes s Bounds (Unplatted)
<br /> , Contractor ��' --� L:, ,; Sec. Twp. Rge
<br /> . ]lddress �.+„� �-
<br /> � �i/, ".�„ ' c r � •>'�� • c;F- G o,r /z
<br /> - .�-�=� �-^ �,�.� i�-n ' T�i�
<br /> Cfty i',�<ci°r j� Phone Sr�%�F" Builcin Use - '�' " <-'
<br /> _ 4 S�.' ,,, �,' i7r� Ir.ri'C -v �:;,.,:
<br /> � � . ;; State License Number Describe Work to Be Done !��.� ,;,.�;�:<.�,�� n��`�
<br /> , . . . �i Ezpiration Dat� � /.a,,,.,,�✓r: ti� � . '
<br /> _ i) i� <
<br /> '� ' SICETCH YLOT PLAN BELOi9' • '
<br /> ' � i • .
<br /> + IIse of Buildin `, - � '
<br /> 4 i,-,i-'n e c^ �.[� U,
<br /> _� . ' . []New ❑ Additio�i
<br /> .. . . ❑ Repair/Remociel
<br /> � . � � � � . � - Valuation of Construction $ � '
<br /> e
<br /> "�,;,. . - ' .. PIAT PLAN REQUZREMENTS _
<br /> + ' , Zndicate lot size, name of streets,
<br /> ` ' indicate location and width of
<br /> ' . . ' . � . � alleys, locate pr000sed and all � �
<br /> � � `� � - . �. existing buildir.gs, sho:a distances
<br /> - � �� �� � � � ' �"� '! - � � � - - to property lines, show distances
<br /> � - between buildings.
<br /> _ . . . Lot size ��F X ��7 L���, �J�.. � .
<br /> . .. � Lot area �i'�� r : -�( , Sq. Ft.
<br /> � .:. - � Size of Bldq, ; ; ;i x�% Sa. Ft.
<br /> ` � tSUmber of Stories
<br /> ! _ . Basement ��
<br /> :.. _- ' / % / '1
<br /> � �� Signed By Ji.. .,/7 �� ._�
<br /> _ ;.� I
<br /> � � � Por i'ni.�/_. /i ,,,;��� �
<br /> Owner Phone �r' �,�, i" 1 '. �i
<br /> DO ;IOT l'ZIT: B�LOFI THIS LI:7E-20R CITY USS 02IL'I
<br /> Date neceived �J // S! Uce Zon�- Z _ �
<br /> -� -
<br /> P1an Caec:; )7ur.,be- 7�j -Z�C7 Fire 2onc ,� '
<br /> �
<br /> Valuation / ���, /.L �/ Occuoancy Group .j
<br /> Q U
<br /> Pemit Fee � �i � � Type of. Construction �V - �- � .
<br /> �S'�C.i •
<br /> Plan Check Fee � (,Q - Occupant Load
<br /> . � Total k'ee Due '�� � • �' �� Sprinklers Required �
<br /> Date Iss�ed �/ y/% ) � � � ' -��� r�
<br /> ' • � � ;ii� ' ' i
<br /> . _ , . , i �. .
<br /> I;v4 i-L�.:.II i
<br /> � D,'t�_j�.ti / '�� , �
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