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IIUILDING PERMIT APPLZCATION <br />Applicant To Complete Ti�i� Form <br />% �� �`� <br />_�/�0/-� <br />If more than one building is to be constructed, submit a separate permit ap- <br />plication for each building. A separate permit will be issued for each build- <br />inq. � , / <br />Owner� (� �__ , � � � IIuilding nddress �� �i /�� �'�"rU� <br />Address �%�� �/G'�'G'�% LoL-�c� IIlk. ll'7� Sec. <br />City �✓�.Z-�!T Phone Z�.j 2 5%�j Twp. Rge. <br />Architect <br />Subdivision (Plat) r�—'✓�.:�L�`7� <br />City Phone Tletes & IIounds (Unplatt�d) <br />Contractor(i,��,c._.SFt �Y�JIC(:'-. IY��� <br />Address � M �GFC��)�SG.t1 <br />City d C: %a"r'1Z.t- Phone �� r y"�� �� Buildii�g Use C� �/.iC� F- <br />State iicense 14umber'� `� 3-� I- 375�`J Describe l4ork to De Done <br />Eapiration <br />_fZf : Pn� (z �C t t�"� i�r�N�r,nc,�. <br />IIse oi IIuilding� Q UC� , <br />'__New -. Addition �-Repair'F,enodcl <br />=� Ct^U r' � <br />Valuation cf Construction $ _� _ <br />PLOT PLA:J <br />Uidicate ].ot size, :i�me of streets, <br />.. i.ndi.catc locaticn �nd �;idth of <br />alleys, locate yroyoseci and all <br />. existing Uuildinc,s, show distances <br />� to proper.ty lines, show distances <br />beLareen buildinas. <br />Lot- siu x <br />Lot arca S.P. <br />Size of llldg. S.F. <br />Number of: Stories <br />llasement <br />Use 2one <br />',� Si9ned Dy %3 �/�� <br />For ��<l=� ,1.J�-,rv����.� <br />owner <br />UO NO':' 1';!?Il'E DG7Al9 TIfIS LINS <br />i <br />DaCe Receiv�d �� ZO %i <br />Ylan Check NumUcr. � <br />Valuation ���L�1C�� . � <br />�O <br />PermiL Fce ��• �_— <br />Pl�n Check Pce _ <br />Total I'ee Due L¢� �� <br />l <br />Pcrmit NumUer �."-�,(' � � _ <br />„� 1. <br />natc Issucd � � •-i 7 <br />USE ONLY <br />Firc Zenc <br />Type of Construction <br />Occupancy Group <br />Occupant Load <br />Sprinklcrs Required <br />APPROV[D FOR QUILDING PERMIT <br />n.,�� <br />