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� <br />, <br /> i` <br />� <br /> I� . � BUILDZNG PERMIT APPLICATION , <br /> . ..� <br /> - Applicant To Complete This ^orm <br /> If more than one building is to be contructed, submit a separate permit applica- <br />' tion for each huilding. �� separate permit will be issued for each building. <br />' O�mer � o �a# c ,a �; � ��'�'��. Buildinq Address l �<-,� �20(��.'r�l �v�_ <br /> Address iFi4 p- v 'rc�z A �.-- n:• Scn�nF Lot3%-4z- 33'"�F Slock �i.sJ <br /> City S�==,�1 Ti' c- Phone 1 f'f� k'7� � Subdivision (Plat) Yb'� "_ R� _ ' ' <br /> I •.p. ,::,�:,-;., t Architect/Enqineer �?�e � S�=a� � Y1°( � O'� •�1 U t.� <br /> City S;=.a�-aF Phone 1Fy- SY7i! Metes a Bounds (Unplatted) <br /> Contractor �'i<<ti�� •; F�� u�> �� �u� Sec. 2t�+p. Rge <br /> Address yLz6 ���`�' �a��. S� , <br /> City �F �t i T/ �= Phone nt >^- TYi v Suilding Use r/-' 1 � S�D 2 F <br /> State License Number 2�3'0 ' -�5��z� Describe Work to Se Done ��GFP�T �- <br /> Expiration Date �U 2`i ' 7 ) C� �" P '��'"'Y� e �_ ��'�'- ���"�n i` <br /> SRETCEi PLOT PLAN BEL0f4 <br /> Use of Buildinq rj���2 � <br /> , []New ❑ Addition ;'3�Repair/Remodel <br /> Valuation of Construction $ Z`30�•��> <br /> "�' .. • . � . . PIAT PL71N REQUIREASENTS <br /> .-= ��;- - . . � <br /> � - Indicate 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 /> �f '�� �� . Size of Bldg. _ Sq. Ft. ' <br /> ���'1p�� � � Number of Sto�ies � <br /> I��% <br /> - � ;.. Basement <br /> � �: . - � - n ' S+ i <br /> a � �. . Signcd Sy l4rs-rt �i��'G t r _ ; <br /> ,; ��• � . <br /> ,. � r�.r: •. , � <br /> F- Far ��..s' ,5,�'f�2- �7" � � I <br /> . � - � Owner Phone ���'_+[�Z � <br />' C ��I� I <br /> ..,i•y � <br /> DO i40T W:2ITG 6ELOW THIS LINE-FOR CITY USE Ot7LY � <br /> . � <br /> Date ?.�ce_ce9 1)_e Zene � <br /> j <br /> . i <br />� Plan Chec'r. ".tunber Fire 2onc <br />' Valuation L Occuoancy Group � <br /> f' 4J_� . �� Type of Construction � <br />� pemit Fee I . <br />' P;en Checl: Fee Occupant Load _ ; <br /> Total Fee Due Sprinklers Required <br /> � : , Datc Issued �� ,G(�r�,!/ <br /> �1 � . <br /> „��+�." ': �L�� �� <br /> I ► � / <br />