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� <br />� <br /> i <br />� <br /> BUILDING PERMIT APPLICATION <br /> � 19�' % <br />� � Applicant To Complete This Form ��/.✓;! - <br /> �._,. , � <br /> If more than one buildinq is to be constructed, submit a separate permft ap- <br /> plication for each building. A separate permit will be issued for each build- <br /> ing. , <br /> . � Owner�U�,� �/� c�.G `i�-y�>c� D/Sl Suilding Address .Z t�/i. (�OL/-+' �f <br /> Address �cJ /,�'� LD �n �,c� Lot :. � lk.S "J' 3 Sec. <br /> City T"u�o2,ffjl Phone Twp. Rge. <br /> Architect Subdivision (Plat)�{•7��/�„� '+�I� /�F'S <br /> City Phone Metes & Hounds (Unplatted) <br /> contractorGlA�5// Q..✓sT Sr�r,,,�,,-. <br /> Rddress R /✓i�/_' �:�f 5n..'� <br /> �=tY � 5r•-.�� f�T'�[I'!/ PhoneU"r-�Q� Duilding Use � G/-/ ob G_ <br /> State License Number ],7 3 - O/-3:5� Describe t9ork to IIe Done�/��,c <br /> , Expitation oate��/�7 �. ��r""�'G'� <br /> /T <br /> � Use of IIuilding <br /> � -14ew . Addition Re air/Remodel <br /> - � Valuation of Construction� '��U <br /> PLOT PLAN <br /> Indicate lot size, name of streets, <br /> � � � indicate location and �vidth of <br /> . � . allcys, locate proposed and a17. <br /> , � er.isLi.ng buildings, show distances <br /> to property lines, sho�a distinces <br /> • ' between buildings. <br /> � . � Lot si2e x <br /> Lot area S.P. <br /> . . Size of. IIldg. S.F. <br /> . . ' Number of Stories <br /> � � . BasemenL <br /> Use 2onc <br /> � . . . . _ �. Signed hy az� � � <br /> . � <br /> For <br /> Owner <br /> DO NOT S912ITG DSLOIJ T13IS LIidG-F'OR CITY D5� ONI,Y <br /> Date�Received �7- '"_ Fire Zonc <br /> Plan Check Nur�ber � � '' - � Type of ConsCruction <br /> Valua"tion 7 �- Occupancy Group <br /> Permit Pee �/� Occupant• Load <br /> � Plan Check Fee `r Sprinklers Required <br /> ' Total Fee Due �-t-v. � <br /> Permit Number <br /> � Dat: Issued /`z. ¢�7�� . . <br /> . <br /> , APPR01(Ep FOR I3UILDING pERMIT <br /> Dale�.___�Y . <br />