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HUILDINC PERMIT APPLICATION / �� <br /> , _ , AppBcant To Complete Thia Form J �� ' � / <br /> � � � �-�/��� <br /> Ila�ore than one buildinR te to be eonetructed, e�6mi! a eeparate permit <br /> ' applieation lor each buiiding. : �eparate permit will be ieeued (or each <br /> building, <br /> .' Owner � � �/ � l�� �11 //�% �,"-�.�J Building Addreee �/ � � � � �•"� � /.^: ;• <br /> .i <br /> Addren �i i// , `--; ` ./- Lot Bloek � <br /> � Cit�`.����,��•��•� Phone t/ ` Subdividon (Plat) . <br /> _�� <br /> `�� ��/- <br /> Are�.iteet/Engiaee r . <br /> Clt� P6one Mete� k Bounde (Uuplatted)_ <br /> Contraetor//=�j; � �;r�yr 7 See. i Twp. 2P� R.ange �� <br /> Addre�� ,���/ i � !� %J' S'/f ��--C`iZ.7 <br /> • z[. S.� <br /> . City l �� ,-d_ 1 � Phone .�i 1'/ ' Building Use v_' � •_ r l�j'��r! �'� A (_ <br /> 97j � /- �.•� J13 <br /> 8t�te.Licenee Number ' Deseribe Work to be Done ���' -rn c p��r` <br /> Fspiration Date �f � �-l�' <br /> SKETCH PLOT PLAN BGLOW � <br /> 'U�e�of Buildtng <br /> . - . II New Q Addition HAepatr/�R�modeL <br /> � Valuation of Conetruction S ���������`�� <br /> PLOT PLAN ?,EQUIR.EriENTS <br /> - Indiute lot eize, name ot etreete, <br /> . iedicate location and width o[ alleye, <br /> . loeate propoeed and all exieNng <br /> bulldinge, ehow dietancee to prop- <br /> erty linee, ehow dietancee between <br /> � . bulldingn. <br /> Lot �ise x <br /> • Lot area Sq. Ft. <br /> Slse o[ Bldg. Sq. Ft. <br /> . Number ot etoziee <br /> ' Buement � � <br /> SiQned By Date <br /> For <br /> Owaei Phone <br /> DO NOT WRITE BELOW TIiIS LINE - FqR CITY USE ONLY <br /> � �_ � <br /> Date Received G- � � � 7� Uee Zone <br /> Plan Cheek Number Fire Zone <br /> Yalwtion peeupaney Group <br /> Parmtt Fee �iC'�� �Ye� Type o[ Conetruction <br /> Plan Check Fee � � Oceupant Load <br /> Total Fee Due Sprinklers Required <br /> Date Issued • � <br />