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- . _ �-.,�. . . <br /> .�2;r ' BUILDING PERMIT APPLICATION /��O p� <br /> ;!�+r � Applicant To Complete This Form 0 <br /> �.�I :''. <br /> �.� ��� n ��s�> <br /> ','r`f�- '� � If more than one buildinq ie to be construeted, eubmit a aeparate permit 73 <br /> k.: . - <br /> '�'�`"''•''� _ � application for each building. A separate permit will be issued for eac <br /> " ' :-•.ulding. <br /> i /� �.� ,r�7 lQ �� � ���� �(�� <br /> `� '. Owaet'�(11.Q . �l\c T m�12hC1.� Building Addreea ^(-d �i �T�.;hQ�IX�I]fJ�. <br /> �:� - Addreee ^F6Q3 ��1a11� � i�1a Lot�Block <br /> �' � �� City�',�ghy�_Phon -) �a,Subdivieion (Plat)���0 ��"''�""' "" <br /> - 1 Archite t/Engineer ���h0"�� 11� R _ - <br /> � ? � Gity�_�one :vletes & Bounds (Uaptatted) <br /> ° Sec. T Range <br /> '� � f � Contracto�,SCl�e'�"��\.�OT�_I� .QI}C', �'P• . <br /> A Address �l�l� �l9 11C1�tOQ� <br /> �; ' , <br /> � � Cit Phc�n 1 ��o� Building Uae <br /> i � . h <br /> State License Number�-y- ,��g Describe Work to be Done <br /> -� Expiration Date �- � -�� V�0 h` ^'�y-""`�'f / . <br /> SKETCH PLOT PLAN B�LOW , <br /> � Use of Building � <br /> ' .II New ❑ Addition Repair/Remodel - <br /> � ' Valuation of Construction $f�l��_OO <br /> ' PLOT PLAN REQUIREMENTS <br /> � ' Indicate lot size, name of streets, <br /> indicate location and width of alleys, <br /> � locate proposed and all existing <br /> buildings, show distances to prop- <br /> . . erty linea, show distances between � <br /> buildings. <br /> Lot eize X <br /> Lot area Sq. Ft. <br /> Size of Bldg. Sq. Ft, <br /> Number of storiee <br /> Basement <br /> gne Date <br /> � For - � �Jv`�`� "�-' <br /> - -- '— -�- —�wne r Phone ��__� <br /> DO NOT WRITE B LOW THIS LINE - FOR C1TY USE ONLY <br /> � Date Received � lIJ S � Use Zone <br /> Plan Check Number Fire Zone <br /> Valuation � � Occupancy Group <br /> Permit Fee � �J U Type of �onatruction <br /> Plan Check Fee �— Occupant Load <br /> d�1 <br /> Total Fee Due �J � Sprinklers Required <br /> i • <br /> Date Iesued � � � � � � <br />