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BUIiUING PERMIT APPLICATION <br />Applicant To Complete This Form <br />`/ ` `;. / <br />p . <br />/;j: �._- <br />If more than one t::llding is to be consCrucCed, cubmit a separate permit ap- <br />pl.ication for each building. A separate permit will be issued for each build- <br />ing. <br />owncr . i" j- ,�(/, S vvl u L1 <br />Addresc "" �> vz � k e <br />City F-��� �,p j{- Phone,355-v`2 �' <br />I�ronit��c /Lr1.��L <br />City Phone_ — <br />Contractor p{� lj <br />Address /.�y z�-�.��� �Y. .r/�i� <br />CitY./�%f'r✓ �,�lv`�fPhone �'>Y%--�/J % <br />�_. � J � <br />State License Number2 7 � �J� �� ?S�Q <br />Er.pi=ation Date �ji„�c.. �f` � <br />Uatc Received� 'L 7 � <br />Plan ChecA rumbcr � <br />Valu�tion / ]/��� .n-`- <br />Permit Fce I%� ��� <br />.cG�� � <br />Building Addreac �1 (p /O ,�jy>,,,v , � � <br />Lot�v <br />Dlk. Sec.____ ___ <br />Twp. Rge. <br />Subdivision (Plac) -=-.�ii�-{�(,%,��f �p�L„�5 <br />Metes s t3ounds (Unplatted) <br />Huilding Use /%( � LrfJ <br />Describe {9ork to De Done��jy� <br />c'.'q7,rcl.! �/� �.C.% <br />Usc of li��.i.ldir,y�� '�'%�u�t� <br />'-Hew . Addition Repair F.emodc <br />Valuation of Construction $��%�7, c''7� <br />PLOT PLAN <br />Indicate iot sizc, name of streets, <br />indicate location ano �vidth of. <br />alleys, locate proposcd and all <br />existing buildings, ehow distances <br />to property lines, show distances <br />between buildings. <br />Lol: siic x <br />Lot area g „- <br />Size of Bldg. 5.1�. <br />Numbcr of Stor+.es <br />llasement - <br />Ucc Zone <br />Signed Uy i.'��� 1/� yi91�:.�,,. _ <br />For <br />Owner <br />CITY USC ONL <br />Rire Zone _ <br />Type of CnnstrucCion <br />Occupancy Group <br />Occupant Load , <br />Plan Check Pee - Spri.ni;lcrs P.equired <br />�i <br />'��otdl FCC DUC ' %• � <br />Ycrmit P:un:ber /I��• � <br />Uate lrsucd <br />APPROVEp F-p�2 p����pING PCRMIT <br />�Y --- --�----- <br />