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DUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />/���� <br />� � 7� <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 Por each build- <br />ing. <br />Owner I-I� ��.. Huildin TddF ess �c7�����3, L- �"�C�E� �-�• <br />Address C�� ���J Lot ��lk. �Sec <br />City <br />Architect <br />City <br />Contractor� <br />Address/7(J/p - <br />Phone <br />Cityli���'g, `(��///,��Q Phone%fG/ iJ�fyl <br />State License Number" (� �. ^'J �o �"/ <br />Expiration Date%� %�� <br />.Date Received <br />Plan Check Nu: <br />Valualion <br />Permit Fee <br />5 <br />6 <br />Twp. Rge. <br />Subdivision (Plat}�,�"-iJ - � , ��_, <br />Dfetes & Bounds (Unplatted) <br />IIuilding Use ��_��s<��l-�� - <br />Describe l•lork to %�e Done <br />����C / ,�-Cl ��� <br />Use of Build�ina � <br />'-.New :. Addition �pair/Renodel � <br />Valuation of Constructi,on $ �O� � <br />PLOT PL1�] <br />InQicate lot size, name of streets, <br />indicutc location and tiuidth of <br />alleys, locate proposed and zll <br />existing buildings, show distances <br />to property lines, show distances <br />bet�veen buildings. <br />Lot size x <br />� � Lot area 5. F. <br />� � Size of Dldg. S.It. <br />Number of Stories <br />IIasement <br />tlse Zone — <br />Signed IIyS� N/� . �:/� <br />For �` <br />Owner <br />Plan Cl�eck Pee <br />Total Fee Due [ (� � ' <br />Permit NumUer <br />Date Issued -'� �� � <br />�2e� G�� � f��--h.��./��,�� <br />C�t�'R.c�r�ev � �c. C=�S�' ''�' <br />Pire Zone <br />Type of Construction <br />Occupancy Group <br />Occupant Load � <br />Sprinklers Required <br />APPROVED FOR l3UILDING PERMIT <br />Datr._. ., <br />