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I <br />BUILDING PERMIT APPLICATION / p / o� 5 .• <br />Applicant To Complete This Form <br />///a�/l� <br />If more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. <br />I }—� ,evelzis MALL <br />Owner �tvjsou -t E\i. Co. Building Address /$/Z �o, eleww''AI Y <br />Address �ErdrZ1T')FS'8(.r_)(r#10V Lot Block <br />City 6E'! ME" Phone 6t-3 •6140 Subdivision (Plat) <br />Architect/Engineer t2ou sl MULVAJJN"f <br />City �E&IT(_E'_Phone (�3-(o445 Metes & Bounds (Unplatted) <br />Contracto:: l c4 4%lgr• CCJ. • Sec. /a Twp. ZB N. Rge eJ E _ <br />Address lee /J• 3-G =G <br />City 4Fd7V_r Phone Mf-4-/SSb Building Use �•7 v%LF_Td/L—�(-/,GT'=�) <br />State License Number 23 .d /- Describe Work to Be Done <br />Expiration Date <br />SKETCH PLOT PLAN BELOW <br />\{�I L+� `-i'tiav <br />E-4 ETT MALL ,F-oo tz Flz <br />T.7 � 7 7 FNTElZP215F_S � Use of Building <br />n New Z Addition Q Repair/Remodel <br />APPRoX. 00 <br />Valuation of Construction $ <br />PLOT PLAN REQUIREMENTS ����•a.C� <br />Indicate lot size, name of streets, <br />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 />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number of Stories <br />Signed By <br />G'es- 644:% <br />DO NOT WRITE BELOW TH.'.S LINE -FOR CITY USE ONLY <br />Date Ceceived-vZcl-%el ULe Lane <br />Plan Check Number Fire Zone 1�3 <br />Valuation Occupancy Group <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Date Issued <br />!/�Z 1-7¢ <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />