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� <br /> � " BUILDING PERMIT APPLICATION /"� C/��`� <br /> , ' . Applicant To Gomplete This Form f � � <br /> � <br /> If more than one building is to be conatructed, submit a separate permit ��.'Z f�s <br /> application for each building. A separa[e permit will be issued for each . <br /> building. <br /> r + r � <br /> Owner� 1. �lV � '1\ �7 BuildingAddress ��c� ,��.ZC��i� �-( ���„ <br /> a I <br /> � <br /> Addrea� �� � � S��� ��� _k�.� Lok_�Block �7�i� — <br /> � [�, � �� ` ^ ` �� <br /> City� ( `.� 'tC. �: v_ Phona - -���Subdivision (Plat) cJl,l`•�l ' I � `� �� C� ,�>' � � _ <br /> -- - J�'�r�� .. <br /> � ^ <br /> Architect/Engineer� ���� '-���L-`�� <br /> City � Phone � Metes & Bounds (Unplatted) <br /> 0 /� <br /> Contracto�l?(� C'�`� 4(�CIQh_� ' Sec. Twp._Range <br /> Addrezs. °� O �t � � � ��! <br /> . Cit�L��'lr -(�{�"' PhonQ Y = � � uilding Use <br /> State License Numberl ..���-I.�.YS Describe \Vork r,o be Done _ <br /> Expiration Date ��.-�.�(1-" /� �'�� j� �� ��-"��_— <br /> SKETCH PLOT PLAN B�LO�V <br /> � Use of Buildit� _ <br /> - QNew QAddition QRepair/Remodel � <br /> ' Valuation of Construction �,�5 S C�.�� <br /> - PLOT PLAN REQUIREMENTS <br /> � Indicate lot size, name of streets, <br /> indicate location and width of alleys, <br /> locate proposed and all exis[ing <br /> 6vildings, show dictances to prop- <br /> erty lines, show distances between <br /> buildings, <br /> Lot size Y <br /> �, �- � Lot arca Sq. Ft. <br /> - Size of Bldg. Sq. Ft. <br /> (.` - Number of stories <br /> ��� Basement <br /> i <br /> �� Signed By�� Date � <br /> ' For �"�n�-�-� 1. A�V r�l 1 <br /> � � � Ownc r Pho e � <br /> DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY <br /> n ,�^ -7 � <br /> � Date Reccived L'2 J r / 5 Usc Zone <br /> Plan Check Number Fire Zone <br /> ,��4��, � �` Occu anc Grou <br /> Valuation ��'- P Y p <br /> � T e o[ Construction <br /> Pcrmit Fee ��. �i YP <br /> Plan Check Fee Occupant Load <br /> Total Fee Duc Sprinklers Required <br /> Date Iseued � ��i' '� ,' ' <br />