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SUILDIA'r, PERMIT APPLICATION <br />- � �� Applicant To Complete This £orm <br />. / ��/� <br />I! more than one buildieg ia to bc eon�trueted, eubinit a separate permit �� �/-l��` <br />application for eaeh buildiag. A eeparate permit will he iseued for eaeh <br />bulldtag. .. <br />O�'ne�����pfv�f�!oi/ HuildiagAddress ����/L'3i � � <br />Addre��('i 7-t/> �l `> 7! Lot Bloek <br />� <br />Cl � ✓ � � �^' -R3f � <br />t�� � Pho ubdivi�{on (Plat) <br />AreLitect/Engiaeer <br />Clt7 i�hone Mete� k Bouade (Uaplatted)� J� �J <br />. <br />Contraeto , = hfj, '9: <<��/ ��' Sec. � Twp. Range <br />.� <br />Address �=// A/� <br />/ �/ / <br />��'�� Buitding Uee /f�y� �'�� i� -� <br />Sbte.Licenec Nutnber Deseribe Work to be Done�vi>i� �-�_ <br />FspiraHon Date � _ �,, �� �/>, 'ys /��� %� <br />3KETGH PLOT PLAN BLLOW �Ps' �'�r- �/�ir���!� ��.�%�i+�f <br />� � i ✓ <br />. � 'U�r of Building �h, cl�.;ic � <br />IINew IIAddi[ion,�[Repair/Remodel <br />Valuation of Conatruction $�POo� <br />PLOT PLAN REQUIREMENTS <br />'' Indicate lot uize, name ot streets, <br />.� iedicate location and width of atleys, <br />, � loeate proposed and all exieting <br />- buildinge, ahow diatances to prop- <br />�, � erty linee, show distaneea between <br />buildinga. <br />Lot <br />Lot area Sq. Ft, <br />Sise of Bidg. Sq. Ft. <br />Number o£ storie <br />' � - ' ' . � ' � Batement <br />� . " � � � . Signed ��i � � Date <br />I <br />• For <br />: �Owaer Phone <br />DO I10T WRITE BELOW THIS LINE - FOR CITY USE ONLY � <br />Date Reeeived"�- ='-�-7 S� Use Zone <br />Plan Cheak Number � <br />Valuation����C� � <br />���� �`�`_ <br />Permit Fee �}-�i' <br />Plan Check Fee • ^�� <br />Total Fee Due�� • ��� <br />� - <br />Dwtq Iseved � �� � 3 - � � <br />Fire Zone <br />Oeeupancy Group <br />Type of Conetruction - <br />Occupant Load <br />Sprinklere Required <br />