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---- -- - - - - - - - - --- - --- -- ---- _ . - --- _ ..� <br /> BUILDING PERMIT APPLICATION I P ��/ <br /> Applicant To Complete This ?orm � f1 . <br /> � �/��o <br /> If more than one build:�.ng is to be contructed, submit a separate permit applica- 7� '� <br /> t.ion for each building.. A separate permit wi11 be issued for �ach building. <br /> , � � � . <br /> j: Owner ����n ? . /_:-�. �>-,- Building Address /�::.-i ,�/,,._,.,.,.cf.a-.f� <br /> Address l�,"� / /';�1�-.��.+-�- Lat i/ri/� Block ;� ?'�l <br /> ��:t; � � . <br /> City r_��. , y7�_ Phone ., r�.;�";G Subdivision (Plat) �ti il�.�„ i^"' �%-;.; <br /> Architect/Engineer _ <br /> City Phone Metes & Bou7ds (Onplatted) <br /> Contractor `��.�{�,� i- /��� Sec. Twp• _ R4e _._ <br /> Address � / � <br /> n `^� <br /> City n;�-,._,,,,J/ Phone Building Use <br /> State License Number Describe Work to Be Done �/, ���.l..� � <br /> Expiration Date /1 J %/��.i_ . � �..,.�./�...-<� <br /> , < <br /> G„ <br /> SRETCH PLOT PLAN BELOW �ii'.Z�..,.,.0�.--� �I�s..,,.,<� -i� W� I .. <br /> � � <br /> IIse of Duildi�ng � <br /> � � ❑Llew ❑ l.ddition �Repair/Remodel <br /> • � r,, <br /> � � Valuation of Construction $ j Op n — <br /> � . PLOT PLAN REQUIREhtENTS . . � <br /> . Indicate lot size, name of streets, � <br /> � � indicate location and width of <br /> � - alleys, locate proposed and ell <br /> existing buildinqs„sho�a distar.ces ' <br /> � �. � � to property lines, show distances � <br /> � . between buildings. ` <br /> f <br /> Lot size x <br /> � Lot area Sq. Pt. � <br /> j . � Size of Bldg. Sa. Ft. • <br /> Number of Stories � <br /> ' �� ._ Basecer.t , <br /> �6igned By i <br /> For � <br /> Owner Pnone � � <br /> — � <br /> DO NOT WRZTfi IIELO[4 TFiIS LINE-FOR CITY USE O�ILY I <br /> Date. 7�c�icefl U:.e Zor_e ' <br /> Plan Cneck 9c-ber � Fire Zone � � <br /> -- � <br /> Valuation Occuoancy Groun ` <br /> Pemit Fee Type of Construction { <br /> . i <br /> Plan Checl: Fee Occupant Load . � <br /> Total Fee Due Sprinklers Reauired � <br /> Date Issued - � <br />