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e <br />' . DOILDING PERMIT APPLICATZON � - <br />f <br />; . 1lpplicant To Complete This ?orm / -��'/� � <br />I! more than one buildinq is to be contructed, submit a separate permit appli a/�/5� <br />tion for each buildinq. �1 separate permit will be i <br />�, �er ssued for each buildinq, <br />/' <br />r' <br />1. c —f�'`�y- <br />"� � Buildinq Address 3J`/�j' �,���.Q�,���• <br />, . llddresa _ �% /r7' �--Q_C��,�./ „����-�. Lot - /S- Block b <br />City _GeC�� phone �-�- --� <br />! _��/ 8ubdivision (P at) <br />� ' Architect/Engineer ' � , � � <br />� :. .I • Q�c�t-�inz� . � <br />,- 'i �itY Phone Metes 6 Bounds (Unplatted) <br />, Contractor ��/ <br />i <br />]Iddress <br />�tY Phone <br />State License Number , <br />�piration Dat� <br />S�%T� PL�T PLAN BELOS4' <br />J <br />.. ' . i . <br />, . . i . <br />e <br />. •, <br />Dat�a �eceived <br />Plan-Cneck :Iur.,Ser � <br />Valuation ( �p. B� <br />Pemit Fee L�'�, � <br />� <br />Plan Check Fee <br />Total Fee Due s , (9C� <br />Date issued C 3 � <br />Sec. 1Wp, Rge . <br />Building Use i <br />, : �`.c:. <br />Describe Work to Be Done �'�'����� <br />��� <br />� C�.t9 5 -ro , rJ Z �' '�-� ,r• � • <br />�tJ 2t�.� 4� -� u�o = <br />Dae of Building • <br />��eN' ❑ Addition Q Repair/Remoi.el <br />Valuation of Construction $-�6,s� • <br />. . PIAT PLAN REQUIRE6SENTS l�v� • <br />Zndicate 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 />bet�+een buildings. <br />Lot size ,�-r'U x /�d <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number of Stories <br />Basement <br />Signed BY q�y „� �-c�.c_�`� <br />� For <br />Owner Phone <br />Uce 2one <br />Fire Zone <br />Occuoancy Grou� <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />0 <br />