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• � • ' ' � DDZLDINC PEAMIT APPLICATIDN � � ' � � t��
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<br />. . �pplicant To Complete This :orm �"� . +
<br />. , � ' . ' : _ ='�r',•-- �.•_f _
<br />'. Si more than ane building is to be contru�ied, submit a separate pezmit applica-
<br />�., tiop for each buildinq. j,separate permit will be issued for each building.
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<br />' /,pypet � �,-., ; ��,; � �-L-/-�, - Haildinq Address ,Z; -�i��9C
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<br />, : lddress �? / .� ,, (,, . Lot -� Slock ' .
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<br />, ' � City _, - : � ! Phone i � _ � O."> ` Subdivision (Plat) •
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<br />• ' � irchitect/Engineer � ' � ,;, • , ', �' , r -�, . ,, � � . .
<br />•'•�� .-•�� City Phone Metes i Bounds (Unplatted) �.
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<br />;,• Contractor . - Sec. 1Vp. Rge
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<br />-. . _: • .•:'' lddress '
<br />� i. City � Phone Ruilding Use �/%.�2.t,,, / ,-x � �%/ ,. � � �_ .
<br />_ ��..;j .. .;; : � _ . . - �'� : .
<br />� State.License Niaaber Describe Work to Be Done� �.�`�
<br />� iy . . . � � r✓ . . � ' :.
<br />• :';I Lzpiration Dat� ' �-
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<br />� • SICETCFi PLOT PLAN BELOW � � '
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<br />j •— IIse of Buildinq
<br />�••r' r'' ^.�. � .,.,,� ' • . � � . .
<br />. .. � .� � � • .
<br />� :- r - F. •I]New ❑ Addition ❑ Repair/Remo6el
<br />, . .,�' �. "� f� �'. �' . �!'"!/,Gi , •• ,
<br />- � . ��-�_• i�l� : _� _ � , • • • oalnation of Construction $ `� •
<br />_ _ � � • . . . - � _ - . � � . ' . • , � . . YLOT PI.AN REQUIREbIEA`TS � . _ � .
<br />,�, . , . . ,e . . .
<br />� Indicate lot size, name of stzeets,
<br />.�i � - � �� '� •indicate location and width of
<br />� . .' ,: j • . •' ,':: � , • alleys, locate proposed and all �
<br />..;.� ', � � ' : , ^ ? existina buildiags, show distances
<br />' \ ''-�., .''---_,.� .. � . , to propezty lines, show distances
<br />' .. � '! • , �, � � - : betveen buildings. �
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<br />'`'l • ' . . : � Lot siz�: x
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<br />� . .' Lot area Sq. Ft.
<br />� � � ��(. ' � � �• � Size of Bldg. Sq. Ft_
<br />' i �. I . , " . '. tivmber of Stories
<br />. " :; , •1 I . , : : 8asement
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<br />, , �- . Signed Sy i ,. , � x� '� �. ' c .
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<br />y � - � � : �I- . , . _ - — . , .
<br />• 1, � ' , _ ' FOY �� .. —
<br />• ' � • Owner P'�one
<br />�� � DO rOT Iti:3IT8 B�LO[7 THIS LI:IE-cOR CIT: USE O2IL'1 �� .
<br />-� Date ?eceived � Dce 2one
<br />' Ylan•CSecn :Jur.ber ' Fire Zone '
<br />Valnation � Occuoancy Grou� �
<br />� PPsnit Fee _ Type of Construction '
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<br />' 'Plan Check Fe� OccupanE Load
<br />, � lbtal Fee Due Sprinklcrs Required �
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<br />� Datc Issued ' _ ' , ••, . � . . - • • .
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