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- - -- -. .. . - --- _ _ - - ,.... <br />BUILDING PEAMIT APPLICATZON / X ��� <br />Applicant To Complete This ^orm �� <br />/��/f' <br />If more than one buildinq is to be contructed, submit a separate permit applica- ,� <br />tion for each building. A separate permit wi11 be issued °or =ach building. <br />(� (� � C� (� <br />Owner }�O.�Y1SC: �.^, + }Z� )Z1�JJi.�+9G�\� (.'� Building Address � .s / 2 � l=��i :^:��.�\',Q' �� <br />� � �� <br />Address Lot ��\� �1 L Block <br />City _ Phone Subdivision (Plat) <br />Architect/Engineer :�,p.< �. l �' � '�,'`-� <br />City �- �� �-�\�f) ?'hone �`CZI47y Metes 6 Bounds (Unplatted) <br />�ontractor T7�� �A�'��1" l.(1 Sec.�_ Twpc�� x4e � <br />Address � � 3 Z 7. LQ IL i�G'G! '✓�' � <br />r. ----,-- <br />City `�,_ Phone ; n1 3 i���3 Building Use � rl�% ��lZ. /� 5 <br />i \ <br />State License Number �7 �^ 01 - IO�o4(p D=scribe Work to Be Done j�Q i�� i�\"�' <br />sxpiration �ate 17'1 c;l,,�� —% S— <br />SKETCH PLOT PLF1N BELOW <br />a '+ <br />�,..�^. ;� i 0_4 <br />Jse of Buil3ing <br />i61New ❑ Addition ❑ �epair/Remodel <br />' U'7 <br />Valuation of Construction 5 � U 0 <br />PIAT PLAN REQUIREhfENTS <br />Indicate lot size, name of streets, <br />indicate location and widtn of <br />alleys, locate oroposed 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 oE B1dg. Sy. Ft. <br />Number of Stories <br />Basener.t <br />_ '.'i <br />Signed By �' � ei cv.l �S� � � `'' � �- l� ".r �� <br />Por 1�� '�(';• \� � C lc v1� , <br />owner Fhone 3�3D � <br />DO NOT WRITG BELOSJ THIS LI:IE-FOR CITY USE OiILY <br />�/ � � , <br />Date ^.ccei�:ed �/ /T_ O��T C•�C% ' u:e ;one <br />Plan Cnec'r. Yurbcr � <br />� v v " �.� -- <br />Valuation <br />Pemit Fee � G� �p __ <br />Plan Checl: Fee <br />Total Fee Due <br />Datc Issuc�:l <br />Fire Zonc <br />Occunancy Grouo _ <br />Type of Construction <br />Cccupant Load <br />Sprinklers Bequired <br />.,'i �.... . ,�, � �. - <br />I <br />I�' �J;'�;t i <br />��1� �h4 � z <br />