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BUILDING PERMIT APPLICATION � � Q <br /> ' Applicant To Complete This ^orm �V '�/` <br /> Zf more than one building is to be contructed, submit a separate permit applica- ����j <br /> � tion for each building. A separate permit will be issued for each building. 7 <br /> Owner �� /� Building Address )7.Z�,f ,�='�Y Y <br /> Address SCU h'i<�2' y r Lot�n Block <br /> City .St=.xTjaF Phone Subdivision (Plat) <br /> Architect/Engineer <br /> City Phone Metes s Bounds (Unplatted) <br /> Contractor ,�jpn�/(„C�'S `E'iv,�=,{��c c�i�r�(.�.,ySec. TWp. Rge <br /> Address �C �'�� i.iN/7i4i4� !¢vk 2 . . . <br /> City S�st-rY�[�_ �.�v�Phone pby3fi�.oyy_� Building Use y� e4//�ie=/vr� _ � <br /> Stste License Number �y,�3 �i /?5'yz Describe Work to Be Done �� <br /> Expiration Date /B�/J'� 75 ` ���`�0�' < <br /> SKET_CH PLOi PLAN BELOIJ <br /> Ose of Building <br /> . � ❑New ❑ Addition [y�Repair/Remodel <br /> � � � ' V^.luation of Construction S,3C.'Cd r�' <br /> . � <br /> • . PLOT PL21N REQUIREh1ENTS � <br /> . . Indicate lot :;ize, name of streets, <br /> � . indicatc location and width of <br /> alleys, loca:e nroposed and all <br /> existing buildings. .show distances <br /> � �a . to property l:nes, show distances � <br /> between buildi.nqs. <br /> Lot size x . � <br /> • Lot area Sq. Ft. <br /> _ Size of Bldg. Sq. Ft. + <br /> Number of StaFies f <br /> • Basemer.t ( <br /> . _ � �") II <br /> _ Signed 9y ��✓T�z r-c-N �'�/C_T) j���7� I <br /> For I <br /> Owner Phone .�j.c/-c�i/��_ <br /> i <br /> ➢O NOT t92I'Pi: II�LOl4 THIS LIN�-FOR CITY US£ 07LY � <br /> Date 'locei��ed �/ •- 7 � U�e 3one ' <br /> Plan Chec't. Numh.er Fire Zone I <br /> I <br /> � /� u� <br /> Valuation r� � J(�� Occuoancy Group <br /> T <br /> ��l . . <br /> Pemit Fee � Type of Construction <br /> Plan Checl; Fce � Occupant Load <br /> Totai Fee Due � / Sprinklers Required i <br /> I <br /> L � <br /> Date Issucd ���7i5�� 7 . ' j <br /> / <br /> �c.� � • l(— I y- 2�- I! <br />