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BUILDING PERMIT APPLICATION <br />Applicant To Comple[e This Form <br />/9�..3 �" <br />y/y/s- <br />If moze than one bailding is to be conatructed, eubmit a eeparate permik <br />applieation for each building. A eeparate permit will be iasued for eaci� <br />building. �ljC,�J�� <br />Owner (�Z�j/�//��f�/Y � '� _guilding Addzesa ��`j7� .�,P�U//l?f/ <br />Addresa Lot�BloekSlp7_ J). Dd <br />City Phone Subdivision (Plat)_ �'.�_,��// <br />Architect/Engineer <br />City Phone Metes & Bounde (Unplatted) <br />Contractor/��%�(_'QfYSf,�/t'L' See. Twp.__Range <br />Addres s_ �/�%d�,2 fr7 <br />City Li%� PhanSQ�ZEz�uilding Uee �i.:r%'71i1'71.O�CG41/ <br />State License Nvmber Describe Work to be Done� Of�- G <br />;�7( ��"`�. <br />Expiration Date 3/ <br />� <br />SKETCH PLOT PLAN BL•LOM <br />Date <br />Uae of Building � _ <br />.0 New [] Addition epair/Remodel <br />oa <br />Valvation of Conetruction 5 ��S(� <br />PLOT PLAN REQUIREMENTS <br />Indicate lot aize, name o[ streete, <br />indicate location and width of allcys, <br />locate proposed and all existing <br />buildinge, show distances to prop- <br />erty lines, show dietances betwcen <br />buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number of atoriea <br />Sasement <br />C�" �i _ • J / <br />Signed 8}�1�7yiL_/g.�u,.Date �/7�� <br />� � crt � —�—T <br />Forl��'d�� �� �.C�/w''C.• �'/ — <br />� Owner Phone �S 2 -L // <br />LINE - FOR CITY USE ONLY <br />� <br />Uee Zone <br />Plan Check N.imber �S-(� lQ <br />Valvation �'� �-��Li�_� <br />Permit Fee �h��� <br />� <br />Plan Check Fee <br />Total Fee Dve �Z+�- �� <br />DateIesucd <br />Firc Z <br />Occupancy Group <br />Typc of Conetruction <br />Occupant Load <br />Sprinklere Required <br />„ ' j / ,—�-_ <br />�i , , , , <br />