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. ' • BUILDING PERMIT APPLICATION ` , . <br /> . • � Applicant To Complete Thia Form ��� �� <br /> If more than one building is to be construeted, submit a senarate permit <br /> application fot each building. A separate permit wi!1 be issued for each � 7��` <br /> building. <br /> Owm.r �p �� ��/i^j�� Building Addreas . `.,: �.,. ��, <br /> Fddresa..,�r�/" � ;� � - '?� Lot / ,'✓ Block '� <br /> City.�G.'/.��%/% Phone Subdivision (Plat) ,�t i„�;• � ��i•; ���� ��c� <br /> Architect/Engineer - � � � <br /> City Phone Metes & Bounds (Unplatted) <br /> Contractor n-'_'i � '"i� � : . � � Sec. Twp._Range <br /> . Address C�� ��,Y .-�/S� <br /> City�„3�/�F/� Phnne�,s,.2�(l/,. Building Usc�//J<_,��;. �" <br /> State License Number,;j.r3-o/-O/o�Sj Describe Work to be Done /�7ipD��.y , <br /> � <br /> Expiration Datc j��7/ <br /> SKETCH PLOT PLAN B�LO�Y <br /> C��C'�^" Use of Builaing <br /> .I� New �]'Addition ❑Aepair/Remodel <br /> T--�� <br /> . Valuation of Construction S_t:-,. y,� <br /> 'p—^ ' � <br /> � PLOT YLAN REQUIREMENTS <br /> I � 1 ` �. Indicatc lot .size, name of streets, <br /> `,�:�� indicatc location and «•idth ot allcys, <br /> � � locate proposed and all e�isting <br /> � —�— � �� (. ~ buildings, show distances to prop- <br /> � � � .� evty lines, show distances between <br /> , 'R buildings, <br /> �`,,.. � <br /> , ( � � Q <br /> I �! � LOt 61ZC ^', Y <br /> L f�� o�$�'�� n � Lotarea -( �C� Sq. Ft. <br /> I � <br /> � � <br /> I �� Size of Bldg. 3�].5 Sq. Ft, <br /> - - -------L'---- <br /> Number of stories � <br /> Basement n/O"1j G . <br /> Signed By--���«l.i�„�;L Datc��i L. `/ <br /> � � �/�J y�, �i <br /> � -- -� � For�'i 2��lCr'N..�f,(�i �- �:—' iG..� <br /> Owner Phone <br /> DO NOT NRITE BELO�V THIS LINE - FOR CITY USE ONLY <br /> � Date Reccived Use Zone <br /> Plan Check Number_ Fire 7.one 3 <br /> � <br /> Valuation Z ,W-0. _ Occupancy Group I <br /> Per:nit Fee �o. J-O Type of Construc[ion u N <br /> Plan Check Fee �a. i�,J-�J Occupan[ Load _ <br /> i ;= , ERCTT <br /> Total Fcc Due_ 3•:,_.}'t� Sprinklers Required pppr(�\!;'h F(1 c i��!ILDING PERMIT <br /> Dete Issued - � � `�.5� . �.�.((.`, <br /> Date_��z�-`1 a-- �'; <br />