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BUILDING PERMIT APPLICATInN <br />Applicant To Complete This Form <br />If more than oue building is to be constructed, submit a separate permit <br />application fox each building. A sepsrate permit will be issued for each <br />building. � <br />� � / L[ <br />Owaer ,a„ � Building Address G% ��p <br />Addresa � Lat�. y�c y 3 Blnck <br />r <br />City fin,Lr��% Ph�ne Subdivision (Plat) <br />Arehitect/Engineer__ �f/� i54-1�( � 3 • <br />' Phone Metes & Bounds (Unplatted) <br />City �.�.1�� _ ^ _ . <br />Contractor� <br />Addrese�l�C �i 3 - <br />City�� <br />State Licenae Numbe <br />Expira[ion Date^ <br />� See. Twp. Range <br />j a'/ O Building <br />SKETCH PLOT PLAN AELOW <br />Describe Work [o be Done <br />��� �� <br />'?�Y�S� <br />`�q�[i o �`✓� Y clr.G✓uia-i �r�tif'lLGVL - <br />�s� '' G(ira.-c� - <br />i <br />Use of Building' /''i�i-� -� <br />IINew []Addition �Repair/Remodel <br />Valuation of Construction $/v�- �� U <br />r^LOT PLAN REQu?REMENTS <br />Indieate let size, name of streets, <br />indicate location and width of aileys, <br />locate propr.sed and all esisting � <br />buildings, uhow dic[anc^s to prop- <br />erty lines, show distances between <br />bui.ldings. <br />iot size <br />Lot a <br />Sizc uf Bldg. <br />Numher of stories <br />Sq. Ft. <br />Sq. Ft. <br />Basement <br />Signed By��/Y.(/�:Titri,(i.nrov�Date�- /'�%- %5 <br />/ � <br />For li� v1•/ �I,JY�+-�l �x � <br />ptvncr Phone n 7-3 P/ D <br />DO NOT WRITE BELOW THIS LINE - FOR GITY USE ONLY <br />_ � <br />Datc Received ��"� d--7 �_ Uae Zonc <br />Plan Gheck Numbcr_ <br />Valuation � � � G � <br />Permit <br />Ylat. Cheek <br />Total Fee Due � � � � <br />Date Iefiucd �L��Q'��' <br />Fire Zonc <br />Occupancy Group__ <br />Type of Construction <br />Occupant Load <br />Sprinklers Requireti_ <br />\ <br />