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BUILDING PERMIT APPLICATION ` p3_ J� <br /> Applicant To Complete This Form � 0 <br /> /� � <br /> If more than one building is fo be constructed, aubmit a separate permit <br /> application for each building. A separate permit will be issued for each "?/�/C <br /> building.n - �� . <br /> jv > � G1:i�E�7� <br /> Ownerl'///,'%�Gd.�'.,CLC� Building Addreea Qol � tc2/ <br /> .� � , � r�„ <br /> Addrese Lot � —� Block � <br /> City ..��Phone Subdivision (Plat)�,/�.f,>..r?i / {��T,�� <br /> Architec[/Engineer <br /> City Phone Metes & Bounds (Unplat[ed) '' <br /> Contractor��,���j'��;���j�.r Sec. Twp. Range <br /> Address���� /5`��__ - : I <br /> ' City1�Phone `.S._1 ��`Building Use i/rf»->r»['/� .t,f� <br /> State License Number,�?j-��/_ /1�t.3 Descri6e Work to be Donc , �fi�/� � <br /> . y'ltr�--�t✓ S- �_�rr-,r�� / <br /> Expiration Date � <br /> . SKETCH PLOT PLAN B�LO1V � � . <br /> Use of Building• � � <br /> - .II New []Addition epair/Remodel <br /> 0 <br /> Valuation of Construction $� n�� � <br /> � PLOT PLAN REQUIREMENTS <br /> Indicate lot size, name of streets, � <br /> � indicate location and width of alleys, <br /> Locate proposed and all e�isting � � <br /> buildings, show distances to prop- �' <br /> erty lines, show distances between� <br /> buildin gs. <br /> Lot sizc x <br /> 7.ot area Sq. Ft. <br /> Size of Bldg. Sq. Ft. <br /> Number of stories <br /> Basement <br /> Signed By Date <br /> For <br /> Owner Phone <br /> DO NOT WRITE BELO�V THIS LINE - FOR CITY USE ONLY <br /> � Datc Received Use Zone <br /> Plan Check Number Fire Zone <br /> � Valuation � Occupancy Group - <br /> Permit Fee Type of Construction <br /> Plan Check Fee Occupant Load <br /> Total Fce Due Sprinklcrs Required <br /> � Datc Issucd � <br /> —::. <br /> � ��\ '-.c: .. <br />