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� <br />, Butt.nrrc f'i:�`17T nrrr.tcnTrnri : <br />. Applican[ 1'o Complete This :'orm � � ' "( <br />21 more than one buildLnq in to be contructed, submit a separate permit appli�i- , <br />tion for each buildin3. �1 separate p�rmi[ Will bu issued for each bualclinq, <br />Ovner ; � r <br />�- ' �� Huildinq Addresa <br />Addr '�' . ,a�. <br />es! .�' ./, ; i � �" " �-----�_ <br />' L'�t Block <br />L— <br />City ! I , ' �.`1 i ' Phone ' . , Subdi4lsion (t�latl ,; � --- <br />�� �h <br />Archltect/Engineer ' - <br />. -----�.�_ - <br />Cltp <br />Phone <br />��"�_ <br />Co.itractor i <br />��__�', � � <br />, , <br />Address (�' � �7 ,. �f ) I , , 1 <br />CitY . ! /,'l /��i, Phone �g7 � , ' <br />State License Hcnber - ., <br />E:piration Date ' , � <br />. <br />P <br />': <br />. . � <br />SICETC}f PLOT PI.�1N £IELON <br />� 112� . <br />� <br />I ' - <br />I' , . <br />I � ' � . <br />- I 1=X�.ST1k, . <br />I ,y: �i, He,�"� I ' <br />� � �—� Ni''l� I �/-'�. •/ <br />� � 900i ��, .. <br />i <br />I <br />�. , <br />� <br />' <br />Netes i Dounds (Unplatted) <br />Src. 1Wp. Rge — <br />Buildinq Use �j ,' �: � <br />Describe Work to De Done � �� <br />. � _c:_��Qi 7 i •,}, � <br />' ' � " � ( N ' -a, i �- <br />Oae of Building <br />❑liew �0 Addition ❑ Repair/Remo::el <br />Valuatlon of Constzuction S�'��,• - <br />PLOT PLAN PEQUIRE�IE:7TS <br />]t�dicate lot size, name of stre�ts, <br />indi.cate location a�d width o: <br />allcys, locate proqosed a:;;: all <br />existing buildi :qs, sho•.0 dista�ic��� <br />to property lines, show dist�n��es <br />betwecn buildings. <br />Lol: size /,; ; , x c� ; ,,. - <br />•Lot erea -- <br />Sizc of Dlag. Sq. Fr. <br />Lurtiber of Stor.es 5�� 4�' <br />1 <br />Basement _� -----�—. <br />S L_ 1y ;� 1'_----- <br />Fi.g�ed By � !. :/ �', �j„.`. _ - <br />pn� I .. .. __ <br />-�LLJ-�...��_—_— � ' . , <br />owner T>hun_- —_-- <br />------ n„ . .. „ . <br />_. - -- ...-- . _.. __ .------ - - -- ��'' CITY USc n:;l.; <br />Late S�ceived � • � ---- <br />Uce Zom <br />Pla� C:icc:: `tur..5er <br />Valua;icn J�9��. � <br />rerc,it Fce ¢�'. �' <br />Flan Check Fee 2�.�• � <br />7bta1 Fee Due CO�� � <br />Datr ]-ssucd •1/� "�� <br />—T <br />Fire 2onc <br />Occuoancy Group <br />lype of Construction <br />Occupont Load <br />Sprinklers Rr.quired <br />' ' CiTY nr rvff <br />APPROVF[J I OT; Fi'�Il �IWG PL�, � <br />