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, � <br /> � F3UILDING PERMIT APPLICATION �// / <br /> � , � � � . �� Applieant To Complete Thia Form � � � � / :� ' <br /> It more than one building ie to be conetructed, eubmit a separate permit J��/� ' <br /> ' application for each building. A aeparate permit will be iesued for each <br /> building. <br /> Owcer_� f-1..� . � ' '. i�-' Building Addrese ;r-�/�,7-.. !,.' .i ` ._ <br /> Addreee Lot�_Block . � / 7 � <br /> lY <br /> " ' '��'S�7bdiviaion Plat � � �- , � i tc�' � <br /> City_S�= Phone_Ll,�_�41, ( ) /�>,.�z.�rf�. h�t�L, _/ �' G"� <br /> . . � <br /> Architect/Engineer _ ' � ' . <br /> City Phone Metes & Bounda (Unplatted)_ � <br /> . - Cantractor`�r? ;�;'_' i�'� -�'.� Sea �� Twp. Range <br /> Addrese /��-9.'�- - � <br /> .. .j3�¢"f n ,�-r, <br /> � � City - -� - �-.- 'Phoneq.�:s'-/.[_2�uildiag Uae ����-�L' _ � <br /> �, _ ' / / <br /> SWte.Licease Number�,?.3-�-� t( Describe Work to be Done� . <br /> Expiration Date. 'y-� ��- - � -��/T� � <br /> P,iiETCH PLOT PLAN BLLOW � � <br /> � � � . � ' � �Use of Building� /l�`,�`tr� G _ - � <br /> � � ' � . IINew QAdditioa "�Repair/Remodel <br /> - N� <br /> � ow�cr . . � � . � � . . ValuaHon of Construction 5 />i, ,�S"di•, pC� � <br /> \'alu�ticn _—�'�rmil_ . . . � �� <br /> Flan Ck�--''01��- — PLOT PLAN REQUIREMENTS <br /> �--- <br /> ^_�— I •p�.� Cnrr. <br /> - R°'° �,.p.,� � a�a'd . Indieate lot size, name of streets, <br /> f.cta:in�� �I �o <br /> � _. _F___�-- . . '� _ ' . � indicate location and width oi alleys, <br /> . � �_ I_ . ._ .�i_--' . - locate proposed and all existing <br /> � I �I�n I � buildings, show distances to prop- . <br /> � 3=3 7-7�=�— ti a�n8s, show distances between <br /> ��s--� ¢q e <br /> Plan Gicck No. . .. ' l � �,, <br /> Scr_--�---- °t-�-- I?! eize •3 ,�x <br /> � Lo! area .�%L�� Sq. Ft. <br /> Size of Bldg.� /�Sq. Ft. <br /> � . . . � Number of storiea ��-�/E= � <br /> . • � . .. . � . . . � . Basement ./.' '� � . .� . <br /> r ' � Sighed By ' �Date�J� <br /> . • For � jJ• /�� <br /> ,� - -' �Owaer Phone �%,'s= /4-.5-7 <br /> DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY � <br /> Date Received �' 7� 7\ Uee Zoac <br /> Plan Check Number - Fire Zone <br /> cg O <br /> Valuation ���9� Occupancy Group � <br /> Permit Fee 7C� - �� �� Type of Construction <br /> � Plan Check Fee • ' Oecupant Load <br /> Total Fee Due � Sprinklere Required . .� � <br /> � � ���/��2f�r,; �Ot ��',lnrc _��� r :', ���� <br /> ' Date,Ieaued � � ' � i � <br />