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, <br /> � % `'� .�' / <;: <br /> BUILDING P�RMIT APPLICATION / _ / <br /> Applicant To Complete This Form //�;,1,�"�� =. <br /> If more than one building is to be c��nstructed, submit a separate permzt ap- <br /> plication for each building. A separate permit will be issued for each build- <br /> ing. . <br /> Owner !�� , � , � ( � �. r.n l : Building Address_: /;'--; - <br /> �.1� . <br /> Address �;..�-.'_ ', .� ' Lot IIlk. Sec. ' <br /> Cit % c--e: �..�-(-�_.__- Phone /�, � . .._, Twp. Rqe. <br /> Y <br /> I�rchitect � Subdivision (Plat) <br /> City � Phone Metes & sounds (Unplatted) <br /> , <br /> Contractor. � :. r� <br /> � <br /> Address " <br /> �gty � Phone __ Building Use _ <br /> / <br /> . State License Number De�cribe [9ork to Be Done%� ,�":.��._� . <br /> Expirati�n Date <br /> _ - <br /> i <br /> � Ose of Building '-id� �� �-����� <br /> �__Nee� - Addition Repair/Remodel � <br /> � Valuation of Construction $ �, � - "� <br /> PLOT PLI�N <br /> � Indicai;e lot size, name of streets, <br /> indicate location and width cf <br /> � alleys, locate proposed an3 all <br /> � � existin3 buildin9s, sho�a di.stances <br /> � to property lines, show distances <br /> � ' between buildings. <br /> Lot size x <br /> Lot area S.r. <br /> Size of IIldg. S.r. <br /> Number of Stories <br /> � Baseroent ' <br /> Use Zonc <br /> /,, <br /> Siqued IIy�-c�%I � .,j'!L �' �C .l ��<�� �C�C- <br /> � <br /> ror _ <br /> Oorner <br /> DO 1dOT F7RITE UILOF: TIIIS LINE-POR CITY USE ONLY <br /> Datc�R�ceivcd Pire Zone <br /> 1'lzm Check rumber � Type of ConstrucCion <br /> Valu3tion Occupancy Group _ <br /> Purmit I.'ee OccupanC Load . <br /> Plan ChecY. Fce - Sprinl:lers l:equi.red <br /> � Total Pee Duc <br /> Yermit Number <br /> �utc Issued _ � � . <br /> FlPPROV[Q FOR BUILDIPJG p[7MIT <br /> Datr,____ <br /> ___f;y_____-__._ <br />