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i <br /> BUILDI.IG PERMIT APPLICATION � ��L' �/'i � <br /> , . _ Applicant To Complete This ^orm � �;� /�,� � <br /> If more than one building is to be contructed, submit a separate permit applica- � �/'/ , <br /> tion f,or each buildiny. A separate permit will be issued for each building. � <br /> � � 1 <br /> ONner � � �llu4 :i\Q �. Buildinq Address ��y'7��J `�-Yl�vl-'YI1t�� - <br /> Addresa •�� a�L ��flYl-l.� �� , Lot� Block .�i� <br /> � I <br /> City �� phone Subdivision (Plat) � � QG���1� � <br /> Architect/Enqineer � � ��� �7f�, � <br /> City Phone f <br /> Metes 6 Bounds (Unplatced) � <br /> • /� n 1 <br /> Contractor ��c(� . Q-Q' /�) 1 i � Ph_� Sec. 1wp. Rge <br /> Address � ., 2`1li �1M ,Q.Y� ��. i � I <br /> City A � ��_ Phone �� _N��,'� Buildinq Use ��--� � �i��rrne� � <br /> Stete License Number. ,�ir�.�-C�/- ��'��� Describe Work to Be Done <br /> Expiration Date �j '�O -�� eC <br /> . o <br /> SRETCH PLOT PI.AN BEIAW �� <br /> � Oee o Building L <br /> []New ❑ Addition ��pair/Remodel <br /> � . � � 00 <br /> Valuation of. Construction S � 5 � 7, <br /> � - . PIAT PLAN REOUIREhtENTS � <br /> • Indicate lot size, nnme of streets, <br /> Sndicate location and width of <br /> � � alleys, locate proposed and �11 <br /> � existing buildings, .show distances <br /> � .� . to property lines, show distances <br /> � between buildings. <br /> Lot eize X <br /> . � Lot area Sq. Ft. <br /> � Size of ➢ g. Sq. Ft. <br /> '�� � Number of StoFies <br /> • . � Basemcnt _ <br /> , Signed By � <br /> Fat i <br /> Owner Phone <br /> DO NOT WRITG BELO�J THIS LINE-FOR CITY USE 0;7LY <br /> DaCC �^L'C1�'Ctj �/ ULe ZOrtO . <br /> / <br /> Plan Check Nunbcr Fire Zone <br /> Valuation Occuoancy Group <br /> Pemit Fee �% � Type of Construction <br /> Plan Checl: Fee Occupant Load _ <br /> Total Fee Due ___ Sprinklers Required <br /> Datc issucd CITI' n^ �"" ' . � <br /> APPROVCD I . ., I <br /> t�:.i, , ' <br />