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BUILDING PERAtIT APPLICATION � / �•� // <br /> Applicant To Complete This ^orm ���/7��/ <br /> If moire than one building is to be contructed, submit a separate permit applica- // <br /> tion for each building. �1 separate permit will be issued for each building. <br /> �) � ,� <br /> � Owner �„�.�u,G. .O� �� Buildinq Address � �//��„�.��,J// %o-�- ' <br /> naaress �.�!/3 /`� � : . .,�t.� .� ! Lot / iC slock �o Q�z£ � <br /> City � � Phone�,=-�J��� Subdivision (Plat) �L/r��iPTT <br /> Architect/Engineer f}' , � i->� '�� � <br /> City � � Phone G Sd •'17.?o Metes S 9ounds (Unplatted) <br /> / <br /> Contractor S� Sec. 7Wp. Rqe <br /> Address � > <br /> City Phone 6 S� '��3� Building Use � <br /> State Lice se Number Describe Work to Be Done �'ilZi7�L±� ` <br /> f Expiration Datc vc4�/�7���0�'�/ <br /> SKETCFI PLOT PL11N BEL014 <br /> Use of Building S(.'���« ��'`����``r <br /> • ❑New ❑ Addition �('Repair/Remodel <br /> � ' Valuation of Construction S �C O.c7 C� � <br /> � • • PLOT PLAN REQUIREh1ENTS - <br /> • Indicate lot size, name of streets, <br /> indicate location and width of <br /> alleys, locate proposed and all <br /> existing 6uildings, .show distances <br /> � �. - to property lines, show distances <br /> • between bnildings. <br /> Lot size x <br /> � � Lot area Sq. Ft. <br /> . � - Size of Bldg. Sq. Ft. . � <br /> • Number of Sto�ies <br /> � Basenent I <br /> Signed By�%,^�., r�J, �� � <br /> a ' <br /> For I <br /> Owne Pnone y s.t• Y 5/9 <br /> , � <br /> DO NOT WRITG 6ELOF7 TffIS LNE-FOR CITY USE O:ILY ( <br /> Date . "_ tbc3 Ute Zor.e I <br /> Ylan Chec;: `:un�"r Fire 2onc I <br /> Valuation Occuoancy Groun <br /> Perciit Fee Type of Construction <br /> Plan Check Fee Occupant Load <br /> ':otal Fee Due Sprinklers R�cuired � <br /> Oatc Issucd - <br /> i <br /> I <br />