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._ <br /> " � , .. � , . �� ' � ` HOILDING PERMIT APPLICATION . � . � . "-:. ^�/-.. �,�- �� <br /> ' .. . . . Rpplicant To Complete This _orm ' /�:i t,' ��; .,r <br /> � • ' � Zf more than one buildinq is to 6e contructed, submit a se arate ����� � ��" <br /> • • 41on for each buildinq. .1 se arate p Permit applica- <br /> p permit will be issued for each building. <br /> : ' on,er f r� �,��..yi� 8uildinq Address 'jc; c 3 /5'T�'� S � _ � <br /> , o , Eddress �j'e`G'3 /S"�'y Sf Lot � Hlock Z79 <br /> �tY �G z�zfj` Phoae Subdi4ision (Plat) �v��-f, 7j� ��v j : <br /> _ � • llrehitect/Engineer . <br /> . : ' _.I • � � . . <br /> _ _ ._i City � Phone Hetes i Bounds (Unplatted) <br /> : :�'. Con^ractor S7l//:P �/a�c- �i7�o '� v Twp. R e ' � <br /> � . � CrSec. g <br /> % ' : 1lddress _�s �N�% s��v � . . . <br /> - _ _/3,. . <br /> ': �tY /-ve�� 7`� Phone ,35;3 -j27f' Building Use � <br /> �; . <br /> ., : .. .• " -��:-. <br /> �;i State.License Nuaber 2Z,J -o��i� „} - pescribe Work to Be Done . <br /> . ,F y <br /> ; . �1 Ezpiration DatE �--�j— yC, �E' /�uo � <br /> �� � �, ' SRETCH PLOT PL.1I BELOW' � <br /> _ ' I . � . - <br /> . ='� • , . . • . . � Qse of Bnildinq • � <br /> i. : - . . . . . . . � �New � , <br /> � . . . ❑ Addition (�].Repair/Remo;:el <br /> ' ' ' - ' . • 'Valuation of Construction $ �����c� " <br /> �. . . . , - . . � j . -7-- <br /> �• . � . " . ' . .. � . . � - � � PLOT PI.AN REQUIRE.+L;]TS � . <br /> � � . . . ' � e . • � � . - <br /> • � . , , ' <br /> •. ' • �� , . ' Indicate lot si.ze, name of streets, <br /> . � , � J � . •- . � - ' ' 'indicate location and width of <br /> . :.� - .: : . . � alleys, locate oroposed a:.d all � <br /> existing buildings, sho:v distances <br /> ' : . '� y • . • ^ � • to property lines, show distances <br /> ' ; � � . ' between buildings. <br /> • . ' � � • . � ~ . ' T.Ob 512E y� � . . • . , <br /> "' . s . , � . . . _ . ��� . <br /> � � . Lot area S Ft. <br /> - ij r. - . . � . � � Size of Sld4• Sa. Ft. <br /> . �� . � • Number of Stories � <br /> �,-,. �= � 1 • ' Basement <br /> �� _ . Signed BY !'�i/� �--��� �J l <br /> ; . <br /> For <br /> � . � � , � Owner Phone <br /> . . . DO D10T {tiZ?^L' B'c:,OF7 THI� L2:7E-POi2 CITY DSS Oi7L'1 - . <br /> _ Date Seceived � / �� '7 f � IIce Zone <br /> ' Plan Chec� _Iur.,Ser ' l • � <br /> Fire Zone - <br /> Valua�ion 1���(7 � ' <br /> . , Occunancy Grou� <br /> Pemit Fee /�/ �- ' <br /> Type of Construction <br /> Plan Check Fee Occupant Load <br /> . � Total Fee Due �'S �=' ' <br /> � Sprinklers Required <br /> Datc Issued �" � ' • <br /> . __�� . . . " . - <br />