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i B11F.LOINc PERMIT APPLICATION �'� , ���••r:) <br />• Applscant To Complete This Sorm / �i •y <br />If more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. <br />Weer !i�� , ^t Building Address �' s ir• <br />Address;- Lot Block <br />City f(-: 'f r7- Phone , f' ."f c` (•`i Subdi4ision (Plat) / 'A' '/C: <br />' Architect/Engineer <br />City Phone _ Metes L Bounds (Unplatted) <br />Contractor Sec. Twp. Rge <br />Address t c l F:• si i 7 iy. <br />City ✓F 'F�7 Phone - C .3 7 !-/ Building Use •; t <br />State License Number Describe Work to Be Done -� <br />Lrpiration DatE -) _ / - ?. - _ ! i.: f //_% �c 1' ? i <br />V1' SKETCH PLOT PLAIT BELOW "/ '.Z<• � ti� - <br />' Use of Bul.ldiiig _ <br />' 11 • <br />a a 13New �( Addition Q Repair/Remo:iel <br />• j' Valuation of Construction 5? <br />•-... - ,. PLOT PLAN REQUIREMENTS,•+,' <br />, <br />A. <br />Data Received 1?_,h.,'. 7 J <br />- _r. <br />Plan Check Number <br />Valuation {� _ <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Date Issued1 <br />.7 <br />Ipdicate lot size, name of streets, <br />,indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size x <br />. Lot area Sq. Ft. <br />Size of Bldg. <br />Sq. Ft. <br />Number of Stories <br />Basement <br />Signed By <br />For <br />Owner Phone - <br />IE-FOn CITY USE ONLY <br />Uce• Zone <br />Fire Zone <br />Occupancy croup <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />0 <br />