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' DUILDING PL•R19IT APpLICATION / � � � � <br /> j Applicant To Complete This Form 3 /3�/�S <br /> If more than one building is to be constructed, submit a separatc permit ap- <br /> pli.cation for each building. A separate permit will be issued Lor each build- � <br /> ing. <br /> � �.�. � � �_ <br /> Owner '� a.-,,,. G� ����� � Building F.ddre,s �; -�-�� �.� , ��C-i2�G_r�-t.�� , <br /> Address � �3 a-r/. d-vx-�q Lot / 3 IIlk. �%J Sec. <br /> G �'�r <br /> City G"�-t-��c�ti� phone <br /> Twp. Rge, , <br /> Iuchitect • _ Subdivision (Plat)_�-�.-'+�C{' aZ,,,�/�� /����0l1 <br /> <4 <br /> City Phone Metes & Bounds (Unplatted) <br /> Contractor ��� �lr-��_�� <br /> F�ddress ��� �� �� , <br /> L <br /> CiLy /��.J phone 3 3 7- t��z L Building Use �,., <br /> �— � .r�_L._. <br /> � State License Number'-� } 3`� ��-� �'ir'y Describe F7ork to Be Done ��u—,�;�� `�- ��`u;,v, <br /> . Expiration Date � ���,�--- ! <br /> v <br /> Use of Duildiny <br /> ' -New -- Addition C Repai%Femo3el <br /> e.c <br /> Valnation of Constructi,on $ ,�po o— <br /> " � PLOT PLAN <br /> � � Indicate lot size, name of streets, <br /> ' indi.cate location and �.idth of <br /> . � . � alleys, locate proposed and a11 <br /> - . � � . existing buildings, �how distances <br /> " to property lines, sho�v distances <br /> between buildings. <br /> ' Lot size X � <br /> � Lot area S.P. � � <br /> . Size of llldg. S.E. I <br /> Number of SCories ' I <br /> � IIasemcnt ; <br /> Use Zone <br /> L, � , <br /> . � Signed Dy ��-_ :�.�.,�.c_ <br /> Por , � ��. �. <br /> t I <br /> Owner I <br /> DO NOT F:RITC DEI.OW TfIIS LINE-POR CI7'Y USE ONLY ! <br /> llate Received 3 il�,,c, S Fire £one � <br /> Plan Check Numb�erq. �_ Type oP Construction j <br /> Valuation p�/Q� Occupancy Gro�p � <br /> _Permit Fee � Occupant lioad <br /> Plan Check Pee ' <br /> 4Q �— Sprinklers Pequi.red <br /> Total 2'ce Duc � <br /> Permit Numbcr � � <br /> Date Issucd� � 5 ' � <br /> APF!'pyED fOR L�UILDING P�RMIT ' <br /> Dotc— „ <br />