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•. � � BUILDING PERMIT APPLICATION / Q��y � . ,'+ <br /> � Applicant To Complete This ^•orm D � <br /> /•�/� />� <br /> . If Tore than one bi�ildinq is to 6e contructed, submit a separate permit applica- <br /> tlon for each building. A separate permit will be issued for each buildinq. <br /> O�mer -� i C'� � l Building Address ( j () � — < <�' ����/ _ <br /> , Addiess _j, - �,� �-� �- (" �t Block <br /> City Phone Subdivision (Plat) <br /> Architect/Engineer � <br /> City Phone Metes 6 Bounds (Unplatted) <br /> . Contractor �� bi� �'^� r' C �=f- 7�P� �Sec. j 1 'lVp• ��S Rqe 5�- - <br /> Address f7l> '� 7� c,���l, _ <br /> ��t� � ��2�ic�� -- �t — C��� �' —o 0 0 �7 <br /> City � Y/�/t✓o0 /) Phone � 1�� ` ` '/ �' �- r � c� � <br /> , , ��7�Buildinq Use p��v > f j ^^/� � � <br /> � State License Number �•Z "3 3 , U /_ �i 7�� ( Deacribe Work to Be Done (ZeJ ����� � ' � <br /> Expiration Date '7 �� �� �� - t`( <br /> � <br /> � SRETCN PLOT PIJ�N BELOW' • �� On <br /> � tlne of Building ' � <br /> � ❑New ❑ Addition ❑ Repair/Remouel �/ <br /> . Valuation of Construction 5 �� ) 'Z I �� 0 <br /> . �'T��— <br /> "'��; ' •� PLOT PLAN REQUIREPfENTS : <br /> • Sndicate lot size, name of streets, <br /> ' . indicate location and width of <br /> ' alleys, locate proposed and ail <br /> � � � existing buildings, show distances <br /> • � . '! � to property lines, show distances � <br /> � . • between buildings. <br /> , , Lot size x <br /> �' Lot atea Sq. Ft. <br /> ' ... � � Size of B�-� Sq. Ft. <br /> � � Number of Stories <br /> � Basement <br /> •r•.. ' Signed By -�.i � l�1 <br /> For ��-l(l v, i7 , ,�, .� S-i s (; <br /> ner P one <br /> DO ;JU�: [i�i:� '_:,�'l; :!iI� LI::i:-FC3 CITY USB 0`IL'f <br /> Date _xeivc i U:.e �one <br /> Plan Cii�c:: .._. . . . Fira �onc . <br /> Valuatio� _ Occupancy Grouo <br /> Pemit Fee _ Type of Conslruction <br /> Plan Check Fee _ Occupant Load <br /> Total Pee Due _ Sprinklera Required <br /> �atc Issucd � ''� <br /> �� <br /> a, ��i.c.� l< � 2 7- 7 �- <br />