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BUILDING PERMIT APPLICATION <br />�; t.pplicant To Complete This Furm . <br />� ; <br />�� ��� <br />3�3�� <br />If more than one building is to be constructed, submit a separate permit ap- <br />plication for each building. A separate permit will be issued for each build- <br />ing. i <br />��� �, �� IIuilding Address���i��✓ZG`GC-�� vC� G'�"uL�' <br />Owner ' <br />J' / <br />Address ✓1�c2�� ����Z- Loti/ �' 2 Dlk. Sec. <br />, <br />City � Phone Twp. Rge. <br />, � <br />Architect ' Subdivision (Plat) G�.�� <br />. <br />City Phone <br />/ , �Y- <br />'Contractor �-c�f"���-� ��'� v�"��'�"'/ <br />Addx�ss fi� � �I� -S � � � <br />City_ C�6!�I)���"`��"- Phone % 1 b� --'� � 7� <br />State License Number'� ��-"�'�1--% 66/ <br />Expiration Date�l�^o�/�� <br />.Date Received��7S <br />Plan Check Nvmber � <br />Valuation � ��J � <br />Permit Pee_ � � " "� <br />Plan Check Pee __ <br />Total Fee Due �U�U� _,... <br />Permit Number •� ,��_ <br />n,t� zssu�a / 3 Zi__._ <br />Metes G IIounds (Unplatte _ <br />Building Use <br />Describe l9ork to De Done�����2�.ZL�'Ld <br />�> / / <br />r/I O c4 �����'GLecE�l�i� �,cc�� � . , , <br />��� ,/ /�`. �cG'M�21r/L"`�. <br />i.l�Phira�.citLT�_ - -- / � <br />i - ' /, <br />Use of�Building ��. <br />'� New -. Addition . Repair/Rer�odel�� <br />�� �e. <br />Valuation of Conctructi.on $ l <br />PLOT PLAN <br />Indicate lot size, name of streets; <br />indicate location and tridth of <br />� alleys, locate proposed and all <br />existin9 buildings, ehow distances <br />� to property lines, show ilistances <br />betureen buildings. � <br />Lot size x � � <br />. �Lot area S.P. <br />Size of IIldg. S.F. <br />Number of Stories <br />llasement <br />Uee Zone� �� <br />Signed IIy � � <br />/ <br />For <br />Owner <br />r.rNr-FOR CITY USE ONLY _ <br />Fire Zone <br />Type of Construction <br />Occupancy Group <br />Occupant Load � <br />Sprinklers Re9uired <br />APPROVED FOR BUILDING PCRMIT <br />Dafe_. - <br />