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I BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />if more-than'one building is to be contructed, sunmit a separate permit app ica- <br />tion for each building- A separate permit will be issued for each building. <br />Owner 1] aumCinn Building Address LU,JPG'! <br />l-Oft-�h�t <br />Address k.� _ Lot ' 0 1 11 Block 10 <br />city %d P re '' _ Phone 6 q 6 V Subdivision (Platt) <br />Architect/Engineer LEA-��re� [b e tei H �T <br />city Phone <br />Contractor Exfa00r �FriPn Ccncu!(l? {z <br />Address 7 O''jOsK 7 �l <br />City (`P4p7Wr? Phone 7?6-3syI <br />State License Number )X3 0 � I8003 <br />iratio : Date ( b -/ �'-7 (, <br />'SKETCH PLOT PLAN BELOW' <br />DO NOT VMITE BELOW THI.' <br />/ <br />Date received <br />06. <br />Flan -Check Number <br />i <br />Valuation <br />1 <br />Pewit Fee <br />; 2 • <br />�)--� <br />Plan Check Fee <br />' Total Fee Due <br />Date issued <br />Metes 6 Bounds (Unplatted) <br />Sec. _ Twp-__ Rge <br />Building Use <br />Describe Work to Be Done <br />..Use of Building Lam_ <br />-13New l�Addition 15Repair/Remodel <br />Valuation of Construction s, S00 d <br />SLOT PLAN REQUIREMENTS <br />-Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />4ecisting buildings, show distances <br />to property lines, show distances <br />,between buildings. <br />.I,ot size x <br />Lot area Sq. Ft. <br />Size of Bldg- -So. Ft. <br />Number., of storIes <br />8a crae..t <br />Signer <br />`! For L�-r%/� r^ -J r .i i j h <br />owner Phone <br />ULe Zone <br />Fire Zone , <br />Occupancy Grocp <br />Type of Constructiony_ti1 - <br />Occupant Load <br />Sprinklers Required <br />s <br />