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� <br /> BUILDING PERMIT APPLICATION /� / � , <br /> Applicant To Complete This Form � � <br /> , , 3/�, � <br /> If more than one building is to be constructed, su6mil a separate permit a�- <br /> plication for each building. A separat-e permit will be issued for each build- <br /> ing. <br /> Owner '�-C- ��J �/ � �� � /�. � <br /> � �`�`�Vi� Huilding nddress ��3 3 � �� � c-Y�- '� <br /> !�- �i' _ ' <br /> P.ddress -H' .3•_3 .�_3 q c-.-i�'�c�e_� Lot / 2 Blk. 79,�Sec. <br /> l� <br /> City Phone Twp. Rge. , <br /> . �_ , <br /> Architect • / ., / " � <br /> Subdivision (Plat) C��,-e � ,���t�,. � �--- �C.��, <br /> City Phcne Metes & IIounds (Unplatted) <br /> Contractor <br /> Address <br /> City Phone Bui.lding Use '�Lf:-_-c�c-.,�.._�, <br /> - State License Number' ' - Describe Wor}; to De Done /���i.p���"?�_.,� <br /> Expiration Date �� � <br /> 1'-��.._,c-zc._1�'.�v��t.�v--�-��i � � . <br /> / <br /> - � Use of Building � <br /> • '__New _ Addition . Repair/Femodel <br /> od <br /> . Valuation of Constructi,on $ ln O�— <br /> - � - �LOT PLAN <br /> Indicate lot size, name of streets, <br /> = indicatc location and width of <br /> alleys, locate proposed and all <br /> � � � . er.istiny bsildings, show distances <br /> to property lines, show aistances <br /> between buildings. <br /> • Lot size x I <br /> � Lot area g,r, ; <br /> Size uf Bldg. S.F. � i <br /> Number of Stories <br /> . I3asement <br /> Use ?one <br /> L <br /> s��n�a ny_ / _��� ��e—�1��- � i <br /> ' �/ <br /> Por /� <br /> Owner <br /> _ UO NOT i�R1TP BELOt4 TIIIS I,IME-FOR CITY USE ONLY - <br /> / <br /> ➢ate Iteceived .� � Fire Zone <br /> Plan Check Numbe/r� � Type of: Construction <br /> Valuat;on T �� ""' Occupancy Group � <br /> Permit Pee 9 Occupant Load <br /> Plan Check Pee Sprinklers Required <br /> Total Pee Due � �� � � <br /> Permit Nunil�er ' � � <br /> �ate Issucd 3 /�f 7 S�- ' <br /> i <br /> ��'PR��'L-� FOR DUILDING Pf_Rh11T <br /> o.,i,. <br />