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I <br />BUILDING PERMIT APPLICATION <br />Applicant To Complete This : orm /�7�/ <br />3 /•!E <br />I: tore than one building is to be contructed, submit a separate permit applica- <br />tion for Poch building.. A separate permit will be issued for each building. <br />Omer Ra VAonG/ S74le-VI }y Building Address 60 •2 <br />Address GO.� p/F'jt _T Lot Block <br />City f1 �-r/ Phone3S3-��%9 Subditrisioorl (Plat) / <br />Architect/Engineer <br />City Phone Metes s Bounds (Unplatted) <br />Contractor <br />Address <br />City Phone <br />State License Number <br />Expiration DatZ <br />i <br />SKETCH PLOT PLAN BEL014 <br />fF. - <br />W <br />Sec. Twp. Rge <br />Building Use ? -it !t0%" '•�_�'•�',• <br />Describe Work to Be Done 1,1O(/C •i'�/,3-/Yh�v <br />Use oc Building <br />[]New pi;`ddition ❑ Repair/Remo_el <br />Valuation of Construction. S�— <br />. PLOT PLAN REQUIP—EktENTS <br />Indicate lot size, name of streets, <br />S 'indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />a_ <br />p l <br />Lot size '7; `-^'.�t�/j �• ! <br />.Lot area Sq. Ft. <br />Size of Bldg.-- Cyr So. Ft. <br />Number of Storied— j�� F• <br />Basement <br />Signed By <br />For _ <br />owner Phone <br />DO NOT WRITE BELOW THIS LINE-FOit CITY USE ONLY <br />Date ':cceived U-,e Zone <br />Plan Check .'umber <br />Valuation <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Date Issued <br />Fire Zone <br />Occupancy Group <br />Type of Construction -�T- IAA_ <br />Occupant Load <br />Sprinklers Required <br />b:X.. <br />