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BUZLUING PERMIT I�PPLICATION ��C•-��'-�L- <br /> ; Applicant To Complete This Form r-�. / <br /> , ' `�/,�� <br /> If more than one buildinq is to be constructed, submit a �eparate permit ap- <br /> pli.cation for each buildina. A separate permit will be issued for each build- <br /> iny. <br /> Owner �4 r�./ Li c�� ' IIuilding Address �� 17/ ti Le � ,}�a,.C,� <br /> / . 1 o <br /> Address �y/ i• �- � rn t7:�-r � LotJ_ b� Blk.3� A'OSec. <br /> city �v r � e T f rhone�5,� -�3B'e Twp. Rge. � <br /> Architect ' Subdivision (Plat) � � <br /> City Plione Metes 6 Bounds (Unplatted) <br /> Contractor S� ✓ e �L Lu � r_ h <br /> Address v?�� �r'r. <,,d ��c,� � � <br /> Cily F_ V 2 r�_ Phone�S�,S.S�j+ Building Use I' � . <br /> �a3- o1 srow-E� : c3:�7vy� <br /> � � State License Nnml�er Describe S9or}: to Be DoneT/� � d � � 0 � _. <br /> Lxpiration Date 7�2 c / �7� � �D R� t-c o F - <br /> ,:'� % % <br /> I . .. . - Use of 2s'�ilding f'�;.m i �Y�--d-l—„'c��� , ., a� . <br /> � (;,:F;:r,,! .i _ "�ii;�",f-/ � '_ New �. Addit-ion . Repair/� R d 1 <br /> . � <br /> � <br /> ���. - � Valuation of Constructi,on $.3 0 0 <br /> 1,. �j_�'� _. � � PLOT I'�AN . <br /> ,i�Di�" o�+ ry . Indicate lot size, name of streets, <br /> � � � ' , . indicate location and width of , <br /> alleys, locate proposed and all <br /> �� � . . er.istin9 buildings, show .�istances <br /> � , - � �� to property lines, sho�a distances ; <br /> �� � ' ' bet�reen buildings. � � <br /> �, I�� LoC size .S 0 x � � d <br /> • �--�-- � � - � Lot area S.F'. ! <br /> �� . - � � � Size oi IIld9. /� x � 3 S.P. I i <br /> �' � Number of Stories .2 � I <br /> i � IIasement � <br /> '�, _�_ . - -__. ------ - Use Zone <br /> i <br /> Signed �y��a.,:d:�,�-c�_� I <br /> For <br /> o�mer <br /> DO NOT 19RITP IILLO[9 Tf1I5 LINE-FOR CITY USE ONLY <br /> �� � Fire Zone 1� "• jJ� ;7. - 'e•,�... <br /> Date Iteceived St�i� ��7 C/ � ". • <br /> Plan Check Number � � i(: "' '� � Type of Construction <br /> Valuation - �:��� � �=e:- Occupancy Group T . <br /> � ' Occupant Load � <br /> Perm�t Fee �/��. °�`� � <br /> Plan Clieck Pee !G � '� ' Sprinklers Required <br /> Total Fee Due `-�" � � ' . � � <br /> � Permit NumUer � . � � <br /> Date Issucd � � ' . <br /> APPROVED FOR QUILDING pERMIT � <br /> n,+� . _ " i � .. _ K � � <br />