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<br />� • . � ,, . � � �. . . • • � ' DUZLDINC PER'TIT AI�PLICATION ' ' . �'. ��. � . �, �. .
<br />• i�pplicant To Complete Tliis =orm � � �� ^� � ' •; •
<br />.. . � . . . ; �%/�/a��;-.
<br />• Z3 more than one buildinq is to 6e contructed, suhmit n separate pez:;tit app i.ca-
<br />: tion for each buildin�. A separate permit vill be is�ucd Eor each building.
<br />• .i� ��r �1� M• ��T�-�� Duildinq Address ��F�V (�� Q�L,•lEp�^�;
<br />�'.` •., Address ?410 I"7'� Ave iot lu' Hlock '
<br />, City ,t-VE'RF.iT Phone353��Q.�(p Subdi4ision (Plat) •
<br />, ' t„•�uc -3.�2-Sh"o �
<br />, - drehitcct/Engineer • C,qST v 1�,� • ' -
<br />`:•� "'� City _ • Phone Hetes G Bounds (unpl.attad) '
<br />_ _j �
<br />' � .' . -
<br />.;��. Contractor �oSS SA�fA `�GIU�Jrcl_ Sec._�_Twp.� Rge �
<br />: , �' �;� naare�s 1Z�� 5 A��;�,;i . � � ,
<br />,.�1; CYty }�\�� Phone (� - 3'S3 Building IIse �`ESIOENT'Al,.�' .`�
<br />•il ' . . ,,9'��*�.
<br />� �'yi � State,License Na�er �,2,g- 01 - �l�en Describe Work to Be Done `��''�'~
<br />: :..I Espiratior: Dat� "1 I I �6 • ' �A�SF �i_n�n_ I,,,i ��aa,qae /�¢r. A .
<br />��' '� • SRETCtI PLOT PL1I BELOS4' • r� ��E ii6W�T AS �Xi.>7�� '
<br />: �.� . . • .. . . ' . tr�v,...�, Anxn • ;
<br />Qse of IIuilding
<br />� ` . • � . ' , ,,, � • L�New ❑ Addition ,�P,epair emo:ie
<br />. . ,; ' • , :
<br />� ;� " ` . � . ;' • Valuation of Construction $ oQ0 � �
<br />� 's - . � -.. ' � .- .. . . I .. .
<br />�•�,-• . � . � .. _ .: .�.' ', . � ^ " PIAT PLI1N BEQUTB&`L:1T5 . _
<br />..� . � . . . _ .. . , e . . . .
<br />. . e -
<br />_ _- � • ' � ' � , . ' � " � � � ' Ipdicate lot size, name of streets�,
<br />- • :.4' _. . '. - '' ' •indicate location znc width o� _
<br />_ �-' _ _ alleys, locate nroposed ar.d all
<br />- ' ;'� - � . � • � existing bcildiags, sho:,� distaaces
<br />- ; � • • �'e ' ' ~°- ' : . to property lines, snow distances
<br />. , . .. -
<br />' i ; ' a . ' . between buildings. .
<br />, . � , , , - ' . _ .
<br />• :. � ,.
<br />. � r..
<br />. i.�
<br />.: i.
<br />.: .
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<br />. � � . . • � .
<br />� . . . • . ,
<br />: , , �.. .
<br />. Da[e �aceived
<br />no �o:� �}a*T� �s:.ocr
<br />' Plan C;�ec ; :7ur,ber %� - =�y 4
<br />� �
<br />Vtluation _ 3 C,=���. _
<br />. . • Pexn3t Fee � 4. ���
<br />. . • � Z �' <,)
<br />Plan Check Fee
<br />• c
<br />, � 7bta1 Fee Due
<br />Datc Ts�ucd
<br />. •, .
<br />l: L�
<br />� �p - `--
<br />Lot :;ize x �
<br />'. Lot area Sq. Ft.
<br />Sizc of Bldg. Sa. Ft.
<br />Number of Stories
<br />Basement /'
<br />� � �� ' ////
<br />Signed BY .�/ :%�/__ `//�' { ��
<br />�� ,
<br />,,�
<br />For
<br />Owner Phone
<br />US 027L'1
<br />IIce• Zone
<br />Firc Zone
<br />Occuaancy Grom `
<br />'i'jrpe of Construction
<br />Occupant Load •
<br />Sprinkler� Itcxyuired
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<br />t� '•' '
<br />�f � f
<br />.: � ` �� .
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