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BUILDING PERMIT TPPLICATION / C�`� �/ <br /> Applicant To Compiete This Form /���/'S <br /> If more thon one Uuilding is to be constructed, submit a sepnrate permit ap- <br /> plication for each building. A separnte permit will be issued for each build- <br /> ing. <br /> owner���liIVNI : � '_ I �-� Building Address �DiE� i�i:.�.��/�r-f <br /> Addr��=^���,(>c�- 0�3� �/�. ,�.� LJ Lot Blk. Sec. � <br /> Cit _�?Y`�k� Phoue �7P `,(.5�'- Tw R e. <br /> Y �--`-�---- 1 P• 4 <br /> Architect Subdivision (Plat) <br /> City Phone Metes 6 Bounds (Unplatted) <br /> ' Contractor <br /> Addrese <br /> City . Phonc Buildiny Use �'[��i��.���- � <br /> State License Numher Describc Work to Be �one ��rv � <br /> Expiration Date ��Pc/Y/G wr."Kai �E' � f�wy�,� Plw�y.� <br /> R%;,i� c.�r�-•��.� <�R � lP�;�'Au� nk n�,�� <br /> � I � L�_� /z �.����„ Use of Buildiny /E�„�C•.i � <br /> ��''T ' .-New Add:.cion Repair/Remodel <br /> . z QL �C� Valuation of Construction $.�,�� �- <br /> 1 <br /> PLOT PLM7 <br /> � Indicate lot sixc, name of atreet:c, <br /> � C�+�-wL ��r���, indicate location and a�idth ot <br /> elleys, locate proposed .�nd all. <br /> existing buildin9�, show distnncc, <br /> // � to property lines, ehow dietnnces <br /> ��[� fdC'U5/,UL� (�f1��' ni�- ' betMeen buildinys. <br /> /� Lol eize x <br /> � ,G1«rU1,� �� � �% 7S Lot area E.F. <br /> Size of OZc�g. 5.�. <br /> Number of Stor es <br /> DasemenL <br /> Use 7.one�� <br /> Signed DY ����.,t L>)�=c>.t,'---. <br /> � For .-�n�r.�_a._-. - <br /> Ownc:r <br /> DO NOT WRI1'G R61AW Tf1IS I.7NG-K'OR CiTY USP: ON1.Y <br /> . Uatc�iteceived� , Pirc 2one <br /> Plen Checl: Number ---� Type oE Construction <br /> Val.u�i:ion �.�[ �� �?�'— Occupnncy Group <br /> Ycrmit Pue 2_d- � �" � <br /> . __ Occupant Load <br /> • Plan Check Pee Sprinklers Reyuired <br /> � .Total l'ee Uuc 2A •��' • <br /> Pennit Nunil�.:r <br /> Dnte lesued // /¢�7 1 � <br /> ��� <br /> APPROVEU fOR QUILpI1VG PCkMII' <br /> Dale.___ <br /> __[3Y-------- <br />� <br />