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BLRLDING PERMIT APPLICATION � � , / ' ,�. <br /> Applican[ To Complete This Form j�y <br /> If more than one building is to be eonetructed, submit a separate permit /�r/7.> <br /> appliwtion for each Uuiiding. A separate permit will Ue issued for each � <br /> building. <br /> 0 <br /> Owner � � � 4- Building Addreas�� UC1LC�i � . <br /> Address � � AR) . Lok ,� Block �n'V-� <br /> � � p� <br /> City( L�Lh9 �' Phon 1'1 .. ��Subdivieion (Plat) ?L1(� p 0 1. (l c� n� ��--�' <br /> Archite t/Engineer <br /> Ci[y c _Phone Metes & Bounds (Unplatted) <br /> Contracto��1C,l�v�'- �� CCC- Sec. Twp._Range <br /> Addrea� Cl� (�.( }C%1(��lCQ N��--�� <br /> 1 � ��� ��� � <br /> . Cit � Phon:�-�-u-��r Bu lding Use <br /> State Liecase Numbc�'�j-O�-/IY�Z�Describe \Vork to be Donc . <br /> Expiration Datc r�-c j-�� �--�-+---�`�, \ <br /> ' SKETCH PLOT PLAN BLLO�V v_ <br /> Use of Builaing <br /> � .Q New []Addition QRepair/Remodel <br /> � n ±� ^ CC <br /> � Valvation of Gonstruction 5 y .y l/�, . <br /> PLOT PLAN REQUIREMENTS <br /> Indicate lo[ size, name of streets, <br /> indicate tocation and width o[ allcys, <br /> locate proposed and all e�isting <br /> buildings, show distanccs to prop- <br /> erty lincs, show distances between <br /> buildings. <br /> Lot size x <br /> Lot area Sq. Ft. <br /> Sizc o[ Bldg. Sq. Ft, <br /> Numbcr of stories <br /> Basement <br /> �g�ed By � _Datc <br /> • For \� �� V�LCk.�,./�-. <br /> Ownc; Phone '��l. �6 � <br /> DO NOT tiVRITE BELON THIS LINE - FOR CITY IISE ONLY <br /> Uatc Rcccivcd Uee Zone <br /> Plan Cheek Numher Fire Zone <br /> V8luati nJ � ��� �v Occupancy Group <br /> Pern:it Fc� rJM' ��� Typc of Construction <br /> Plan Check Fee Occupant Load <br /> Total Fcc Due Sprinklers Required <br /> Dat�� Iss�.�rd _ <br />