Laserfiche WebLink
BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />if more than one building is to be submit a separate <br />rmit <br />application for each building. A co <br />nstructed, <br />will be issued for <br />reach <br />building. <br />OwnerEllEt J �o�- y�1Jr Building Address J?'D/ <br />Address FO/ 0HS'/^10 Lot Block_ <br />City ti.1kY_tT! Phone'3,4.'- 7raoftbdivision (Plat) <br />Architect/Engineer Cate�rtire7 C'44-rx — <br />City Phane Mates k Bounds (Unplatted) OI 1 <br />Contracto- Sec. ( Twp.�_Range l7,� <br />Address <br />City _ _ Phone Building Us <br />State License Number _ Describe Work to be Done <br />Expiration Date _ <br />SKETCH PLOT PLAN BELOW <br />r77r <br />�*/s. <br />ytp�- <br />%1'1 rt: K J <br />Use of Building SToKw6F <br />.MMNew ❑Addition [31tepair/Remodel <br />' OV <br />Valuation of Construction $ ,'ZOO <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of alleys, <br />locate proposed and all existing <br />buildings, show distances to prop- <br />erty lines, show distances between <br />buildings. <br />I.ot size x <br />Lot area 3q. Ft. <br />Size of Bldg.--sq. Ft. <br />Number of storios <br />Basement <br />Signed Ay Dat e4 <br />' For t� <br />-- ner 1-one Ru �_ •_" {/O O <br />DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY _ <br />Date Received �--13 -7 :J Use Zone ._ <br />Plan Check Number_ 1 - 124 Fire Zone -- <br />Valuation L L 0'0 • �1-0 Occupancy Group L— <br />Permit Fee tj5-- r-J Type of Construction_. <br />Plan Check Fee 1.5.%50 Occupant Load ,^ — <br />Total Fee Due j q, b0 Sprinklers Required <br />Date Issued <br />