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i .. - , _. €� <br />-- . � �! BOILDING P�AMIT APPLICATION � � � �� • ''= <br />.•� , l�pplicant To Complete This Sorm �< 7c�• <br />j � J�...,/� <br />� • !f more than one building is to be contructed, submit a se arate ���� ' <br />tion for each building. A se arate P P��it applica- <br />,� P permit will bc issued for each building. <br />, � Wner �=,;��..�� q:� 1' ,i- �°. - ; � ' � <br />� ' i' ' Building Address '�. �-. % . '`� i ._ <br />� � •{{ c � � ' i ' <br />1Sddress _ �C L� / - / ,� _ �-1 , y,ot / ; r , (. Block ; � y" � <br />CitY �^_,r�-��(,'�- Ptone_'1_ �L_ �S7-Subdivision (pl.at) �i/!� � <br />Azchitect/Engineer ' �`` . -- _. <br />-/'�jl._ !C �� �!Sl �>_ � _ . <br />1 — <br />City � Phone Metes 5 Hounds (Unplatted) <br />Contractor � ' �.� ' + .. <br />�.�:.;. ;��f-Nd�•�-",. �L�/..Sec: Twp. gge <br />Eddress �L�f �_ 1 � 2 1.Z.,' . <br />�ty���L'�/��u-�;e� � Phone 7J� 1([% Building Use ' <br />, _ .a ,`,. <br />State License Nwsber �7 �? �. i j �a .; Describe Wor}: to Be Done <br />;, , <br />:I� <br />- •...:-i <br />I <br />.l: <br />' . . � <br />:� <br />� <br />., <br />f. . <br />•i <br />-:1 <br />� i <br />F�piration Date <br />r <br />SRETCH PLOT PLAN BL'LOW' • <br />UN 9 1975 <br />c�rY oF.EVERErr <br />tnspection pept. <br />_y�1 ` ��� � /l' /� • <br />. , . + / 'Y ,i <br />IIse of Building • <br />�Ne:w ❑ Addition Q P.epair/Remociel <br />Valuation of Construction $'' ��f('' C' � -' <br />_ i <br />. PIAT PLAN (tEQUIRE9iENTS 5�� ,- <br />Indicate lot size, name of streets, <br />indicate location and wzdth of <br />alleys, locate pr000sed �zd all � � <br />existing buildinas, sno:u distances <br />to property lines, show distances <br />between buildings. <br />Lot �iZe X . : <br />Lot area Sq. Ft. <br />Size of IIldS• Sq. Ft. <br />Number of Stories <br />Basement <br />Signed Hy �;�ci j�"�. Y '.i�i :�l�r <br />For ��. C«� ��v9-;�_„^.-,`,= ,�J <br />Owner � ��Phone .�� <br />_ � :�] 5�.1 �l J t�-� . <br />DO 2701' S•7:2IT� B?LO[9 THZS LI:]E-POR CITY USE Of7LY <br />Date S�ceived Uce Zone <br />Plan. Cyeck `iur,ber <br />Yaluation <br />Pemit Fee <br />Plan Check Fee _ <br />. ,� Total Fee Due <br />Date Issued <br />Fire Zone <br />Occupancy Grou� <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />