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- BUILDING PERMIT APPLICATION � C�/�� <br /> . � Appliwnt To Complete Thie Form / / <br /> S�i�S <br /> II more than one building in to be conetructed, nubmit n eeparate permit <br /> application for each building. A eeparate permit will be ieeued [or each <br /> bullding. <br /> )� �.�,�, ,,�� � f i� <br /> Owner tI 1 1 A\`I�:{11 �1� ���' Building Addreee �..n/�n � �� <br /> -•T�— � Lot !�� alock f�r`��' - - ,� <br /> Addreee <br /> � � �./ <br /> City(�1�� ��0 Q�i Phone� �- ,�� Subdivieion (Platl��[1 � �. I I(P P� ) Y'�Q � n� "�.J <br /> � <br /> Arehitect/Engineer \�_ <br /> City � Phone ��� Metee k Bounde (Unplatted) <br /> � <br /> Contractor �)��n�Q ��-n �j L �/�Oh:� Sec._Twp._Range _ <br /> AddreesZ�rf`�a ['j0(�,� - (071 O��i <br /> �1 <br /> �,�YL�,e ,�p{1� Phme �,y�-��[,� Building Uee <br /> State Licenee N�mber�x�)-(��/-���T?:t' Deecribe Work to be Done <br /> Jn — 1 J� _�� � 1 17 �'��I C�'t 1 l? (�P 0 �)I 1� <br /> Expirntion Date �� `�J <br /> SKETCH PLOT PLAN BELO\V _ <br /> Uee o[ Building _ <br /> � New C] Addition �Repair/Remodel <br /> ��il �.�' <br /> � Valuation of Conetruction ��y���� / <br /> � PLOT PLAN AEQUIREMENTS <br /> � Indlcate lot eize, name o[ etreela, <br /> indicate location and width of alleys, <br /> locate propoeed and all exieting <br /> buildinge, ehow dietancee to prop- <br /> ezty linea, ehow dietancee between <br /> buildinge. <br /> Lot elee x <br /> Lot area Sq. Ft. <br /> Stze of Bldg. Sq. Ft. <br /> Number o[ etoriee <br /> Baeement <br /> Signed 0� Datc <br /> ' For ��� V�n-�'� ^_^ - <br /> ner Phonc _ <br /> DO NOT WRITE HELOW THIS LINE - FOR CITY USE ONLY <br /> Date Received S Uee Zone <br /> Plan Check Number F1re Zone <br /> �C1� (�, Occu anc Grou�� <br /> ValuaHon c � P Y -- <br /> Permit Fee 7.¢. �d _ Type of Cone:ruction <br /> Plan Check Fee Occv!:ant Load <br /> Total Fec Due 7iS�-. � iprinklers Required _ <br /> Date Ieeucd <br />