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<br /> ' HUILDING PGFiMIT AI'PLTCI.ION � ' '� '�
<br /> � Applicant To Complete Tiiis :'orm �� " 4
<br /> If more than one building is to be contructed, submit a separate permit \pplica-
<br /> tian for each building. el separate permit will be issued for each building. �
<br /> Owner :.� �%N/c �" " � G_" ��� �'// Building Flddress � -91/� � /��+ ( �l t;��,>�.., �c,;�.
<br /> Address � iJ; � i . 9' Go t'I,-��,cl Lot B]ock '
<br /> City ,�.',,: � t/ Phone , ;� `,' � .�l Subdivision (Pla`.)
<br /> _y._
<br /> Arciiitect/Engineer � `� ' � i 1 i%i7�/f��J ��t�ti��f c�.
<br /> City Phone Metes s Bounds (Unplatted)
<br /> Contractor /��z-�/,�,..�� �,-, � ��, � Sec. _ Twp. Rge
<br /> Address ?, n ' •
<br /> L �?�
<br /> City .c t�,.�,-� Phone ��%- :/ ',�/ Building Use ?Fi�l'. i',4n,- , � -r,- /, ��� ,
<br /> � i
<br /> State Licen�e Number ��� - c/ -¢yu:: Describe Work to IIe Cone
<br /> Ex iration Date /,-�.!�- C �,
<br /> P _ 7 .i'N, _ ,i�/ iyli,liC[= %i'�lylE,i
<br /> SKETCH PLOT PLAN BELOW � �
<br /> Dse of IIuilding �/iri!/�.-;-.cc
<br /> � ❑New ❑ Addition ❑ Repair/Remodel
<br /> ___ . - ' � ValiYation of Construction $ / [�'�� �
<br /> � .. �:;, .; : :i� LtJ/�,.;/ PLOT PL11N REQUIREi�1E:1TS '
<br /> � Indicate lot size, name of streets,
<br /> indicate location and width of
<br /> � alleys, locate nr000sed and a!1
<br /> EXY�i� 1R��, existing buildings, .sho:o dis' ,.nces
<br /> \ �'� �yQ to proparty lines, show distances
<br /> between buildings.
<br /> C� / t Lat size x ,f f c� Ley.i( iiii-, �",.�
<br /> � , _ �/ Lot area Sq. FY..
<br /> • -t � � , Size of Bldg. Sq. Ft. �
<br /> � '� . f'� r�� Number of Sto�ies �
<br /> �. , �� ` ��_�, Basenent ,
<br /> � - �. \ � .. . - -�7? L : j I
<br /> Signed By i:��.- /, .- � �
<br /> —�
<br /> eoz 7'/L� i
<br /> , �`� Owner P:ione � /S�- C�•// �
<br /> DO NOT{4RITS ➢ELO��l THIS LI?72-FOR CITY USE OtILY �
<br /> Da._ ..___.:c? U_e �one •
<br /> Plan ChecY. vurbcr Fire Zone " i
<br /> Valuation Occuoancy Group `
<br /> Pen�it Fee Type of Construction i
<br /> i
<br /> ' �
<br /> Plan Checl: Fee Occupant Load _
<br /> �
<br /> iot�l .�ee Due Sprinklers Bevuired �
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<br /> Datc Issue3 ' _
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