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� _ <br /> ; y7 <br /> ._ . ---- -�•-- -__... i ������y <br /> If more than one buildina is to be contructed, submit a separate permit applica- <br /> . � tion for each building. �1 seQarate permit will be issued for each building. <br /> p��r ' Bnilding P.ddress <br /> Address ' ": - Lot i Block % <br /> City Phone Subdivision (Plat) �. .� <br /> ArchitectJEngineer <br /> . � City Phone Metes s Bounds (Unplatted) <br /> Contractor � Sec. 1wp. Rge <br /> Address ' � <br /> City / � � Phone _ Buildinq Use x <br /> � State License Number � � � � - P.escribe Work to Be Done � <br /> Expiration Date �/ ' . -; <br /> i SRETCH PLOT PLAN BEL014� ' <br /> —, � Ose of Building � <br /> � � ' �New ❑ Addition ❑ Repair/Remodzl <br /> . <br /> . I �t' <br /> ' Valuation of Construction $ � <br /> ,� , � PLOT PLNi REQUIRE6fEYTS <br /> I I <br /> � indicate lot size, name of streets, <br /> � i I�,. ��� indicatc location and width o: <br /> � - � . � _ alleys, locate proposed and all <br /> � I� � �, � existing 5uildings, show distances <br /> � •r � i � to property lines, show distances <br /> � � � between buildings. <br /> • ' e 'G �-..) 1G� <br /> . I , � Lot size '. / x <br /> 1 � Lot area � ` Sq. Ft. <br /> Size of Bldg. Sq. Ft. <br /> � ._.l f : Number o: Stories <br /> Basement <br /> . ' � .� '=,`% ��- • Sigr.cd Pi � . <br /> . <br /> For <br /> Ownez Phone " � ' <br /> DO ::'v= -" -- " :5:5 Li::=-=v".'. Ci.Y USc O:ii7 <br /> Date 'cceive3 ' � C. Dce �one _ <br /> � ; �_�.. �.._.r. .._c..._r 7� ' Z-7�I- Fire Zonc <br /> Vaioa`:.cr. � lj�� ' �� Occuoanc}' Gzcup <br /> Pez�ciit Fee 2 ����- B � Type of Construction <br /> Plan Checi: Fee ��'J Y• � S� Occupant Load . <br /> Total Fee Due 3 / �� � S � Sprinklers Required <br /> / . . <br /> Datc Issucd 7 2'� 7 ) . - <br /> —T <br /> I <br />