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�.., - . BUILDING PERMIT APPl,ICATION / / O O � <br /> j Applicant To Completo Thi3 Form 3/�s�ji <br /> ' // <br /> If more than one building !a to be conatructed, eubmit a separate permit np- <br /> plication for each building. A separntc permit will be iesued for uach build- <br /> ing. <br /> �Ownes�;0���� � �SGH Auilding Address_�f� �a� /�LJ�/ <br /> ]Iddreca/D/6 _3� Lot/�lk.�_ Sec. <br /> City���_ Phone�� �j' o%� Twp. Rga. � <br /> Architect r • Subdivision (Plat�������� <br /> City �- Phone �-- Matea 6 Dounds (Unplatted) <br /> Contractor .f€�� <br /> Addreas '� <br /> City � phone Building Use��� ' <br /> 6tata Licenae Number' �— ' ' DeacribQ Work to Be Done <br /> Expitation Date �/ � /Tom� <br /> � Uce of Building <br /> . /� �iew :. Addition Repair/Femodel <br /> 4� � Valuation of Conetructl.on $ D � ooiro <br /> �\`/ <br /> � PLOT PLAN <br /> � ' Indicnte lot size, name of atreeta, <br /> ��v indicate location and width of <br /> alleys, locate proposed and all <br /> � exicting buildings, show distances <br /> to property lines, show diatances <br /> between buildings. <br /> . n Lot aiz��x <br /> 1�� / I.ot aree g,F. � � <br /> � . Sizcs of U g. S.F. I I <br /> Number of Stor es <br /> � . 8asement — <br /> � Use Zone <br /> i� <br /> . - - - Signed D I i <br /> � For I <br /> ownar I <br /> p0 NOT {9RI7'E DBLOW TqIS LINE-FOR CITY USG ONLY <br /> Uate Received ���� - 7 r Fire Zone � 3 <br /> Plan Check Numbcr � %�- /�y5� Typa of Conatruction 4 -� <br /> Valuation_ ;1 �,�,� , op Occupancy Group r <br /> PBYIOS.t I'ue �4P. �» Occupant Load - <br /> Plnn Cl�eck Fee ��. ,1..p Sprinklora Required — <br /> Total Fca Due t,i t . o p � . <br /> Permit Numbcr ' <br /> Dntu Issued - f. ,•� 3�Z,F� ��� • K � . . <br /> � .c�� � . <br /> v 3/'Lo/j,$' qPPROVED FOR QUILDING PCRMIT ' <br /> Daln _ <br />