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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />�/�� S <br />If more than one building is to be construcfed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />building, <br />� � � � <br />Owner ' i X� ��� Building Address j�_���,� ��(��-�-� �j(� �__�� <br />Address �� ,. r � ) �� � �� � � ��' Block > � � <br />rL ., Lot-,� .g`_�, <br />City � 4.C_� . Phone' � -C.��4�3 s �ba�,s� n�Plat � , �_'; � � <br />., <br />( )c.��F��alt l�%te' i�� <br />Architect/Engineer <br />�� <br />City -� Phone-��"�---- Metes & Bounds (Unplatted) <br />� � _ �.. <br />Contractar ' � 1 j,� � ` - <br />� �L.L)'.Sea Twp,__Range <br />AddressN��(� i� i`l''tiC�%t ��•.ti. l 1\�1,� . <br />City(1 <br />Lii���� p��o � C_ �C(�3Building Use <br />State License Numbe����j-{ )�--��[�I,'1� Describe �5'ork [o be Done <br />Expiration Date ln-i�O ��5� - � <br />� 1 G� ��i �' �, 1 U-1 rY1�� (' � C�� 1 <br />SKLTCH PLOT PLAN ELLO�V <br />DO NOT WRITS BE <br />Da[e Reccived 7� � %! <br />Plan Check Number <br />Use of Builfii <br />.C1New QAddition ❑Repair/Re�,nodel <br />Valuation of Construction �. �/ 00 <br />. � l i�' i_. <br />PLOT YLAN REqUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and �vidth of alleys, <br />locate proposed and all existing <br />buildings, show dislances to prop- <br />arty lines, sho�v distances between <br />buildings. <br />Lot <br />Lot area <br />Size of Bldg, <br />Number of stories <br />Basement <br />Signed By <br />For <br />Owne,• Phone <br />� LiNF - FnR CTmv rrcc nnrr v <br />Use <br />Fire <br />Valuation�1C,�_ ����' OccupancyGroup_ <br />Permi[ Fee 2..� �� Type of Construction <br />Plan Check Fee Occupant Load <br />Total Fee Due Z 4. �� Sprinklers Required <br />Date Iesued ' <br />Sq. Ft, <br />Sq. Ft, <br />te <br />