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B6ILDIIIG PERMIT APPLICATION / �61 <br />.Applicant To Complete This 1-orm <br />If rare than one building is to be eontructed, submit a separate ' <br />tion for each buildin s P permit building. <br />a+� <br />• g• A separate permit will be issudd For each building. <br />• Omer ("� Yam/ `" ` ��(i�lv Gs c-v wt/ r: ' . <br />, <br />�/f r,;tBuilding Address <br />Address 9,714- _ 3, Lot <br />Block _ <br />MY 4 .z r %i Phone SuWivision (Plat) <br />' Erchitect/Engineer & fi/Pr L <br />'•• -'I city Phone <br />Metes & Bounds (Unplatted) <br />•Contraa^tor I��.�r-airr4y5, N Sec. is TuP. 2'�' Rge 1 " <br />c. .._. .7-Mress1'>77� <br />.CitY .Phone z - - 'Building Use ' <br />•k� State,iicense Nu^+..bc��s�� 'ZZ3 -!� I IOS2o Describe Work to Be.Done <br />'i piration Date _. 1 / I �17 L 'row ,= rc_. <br />' - 'SIZETCH PLOT 111,7W BELOW' - <br />') ixE �? •ilse of Building <br />New ❑ Addition Q Repair/Remc_c1 <br />Valuation of Construction $ S <br />. j ?.PLOT PLAN REQUIr_'•'NTS _ <br />`.j :.Indicate lot size, name of streets, <br />_ 'indicate location and width of <br />- alleys, 'locate proposed and all <br />.-existing buildings, show distances <br />--to property lines, show distances <br />e -a _.,between buildings. <br />t?.ot size 'X <br />Trot area So: Ft. <br />�'. .:. Size of Bldg. So. Ft. <br />' .Number of Stories <br />Basement <br />Signed By �LiI1� <br />3- For <br />Owner .Phone <br />DO NOT 4I3IT' BELOW THIS LINE -FOR CITY USFi ONLY <br />Date received `7 `l( '7,/ Uce• Zone <br />Plan Check: Iu=ber 7 T— 3S3 Fire Zone <br />lVaurtion 4sOO�. <br />• Occupancy Group <br />Fctnit rev l 77 . (�y� Type of Construction <br />Flan Check Fee a Occupant LoaQ <br />'lbtal Fee Due. ZS 3. �U Sprinl:lEr.s Rcg61.Ty'OF FVEREFF ' <br />Data Issued APPROVED FOR BUII,DIP:u^ PERMIT <br />