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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />c-//�/-' , <br />If more than one bui2ding is to be constructed, submit a separate permit <br />application for each building. A separate permit will be i.^,sued for each <br />building. . <br />/"1 �\- � <br />Owner �y Building Address �� �� �j�%�'Yj lf�� <br />1 � �j � <br />Address �llp , .� Lot J Block (')�^- n-�) <br />Cit� y�7� Phon � f/� <br />YC l�i' �0 @�" 1 Subdivision (Plat � I�K.!') <br />Architect/Engineer <br />City \�� Phone Metes & Rouuds (Uzplatted) <br />n � <br />Contracto� (�' Sec. "wp. Range <br />Addr�e�ss�.���tC'��42hV l�.Yi_—�,�� <br />City( ,�tiQ'hp � Phon� �- /(�/ Buil� ding Use <br />State License Numbe�-0�-%/�„2� Describe Work to be Done <br />Expiration Date L-'��- °%� (� , Q 1 .(l ���� <br />SKETCH PLOT PLAN BLLO�V C�j�ry1� -� \�'ah�� L���,,,_,� ��,9-�5-� �,O <br />� r �� <br />� Use of Bvildir� �� `�'�0.'� <br />.aNew I_]Addit:on �Repair/Remodel <br />Valuation cf Construction $�7 �Q(�, GC� <br />PLOT PLAN REQUIRLM�NTS <br />Indicate lot size, name of strcets, <br />indicate location and width of alleys, <br />locate proposed and ali existing <br />buildings, show distancee to prop- <br />erty lines, show distances betwecn <br />6uildings. <br />Lot size <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. I't. <br />Number oF stories <br />Basement <br />igne �r Date <br />Fo _'i-('�,� . ��V���,�ti,..,�� <br />Owner `-- ho�ne ��3"��, I <br />BELOtiN THIS LINL - FOR CITY USE ONLY <br />Date Received (/�/// <br />Plan Check Number <br />Valuation pl � �-4�, �� <br />Permit Fee 2 �- �� <br />Plan Check Fee <br />Total Fee Due 24-_ ��� <br />/_ / <br />Datc Issued t-� �//7� <br />--� �r <br />Use Zone <br />Fire Zone <br />Occupancy Group_ <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />