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BUILDING PERMIT APPLICATION p3,) • ,; '. ,�,.,.F <br />Applicant To Complete This _ orm /� 0 <br />.sore than one building is to be contructed, subnit a separate permit applica- <br />tiou for e�i' building. A separate permit will be issued for each building. . <br />Omer i P4 2'!/ /L 1L_ Building Address <br />k'dress �C• / I <br />._� �� -! // ' I l� Lot Block <br />city %/ Phone —WdS Subdivision (Plat) <br />` = lxehiteet/Engineer <br />L'ity{/�/'L� Phone 1 >'�i16 7 % Metes 6 Bounds (Unplatted) — <br />;�. Contractor -vI Sec. Twp. —Age <br />address f "ZZ�- - <br />I• City!/r/� Phone — " 3 �'- y s z ., Building Use <br />. .��-cr/_ ✓7.i-•i Describe Wo k to Be .Done _ate•'•' <br />State License Number _� <br />".` 1 Expiration Date 41 <br />SKETCH PLOT PIA'7 BELOW <br />-' Use of Building <br />nNew MAddition ❑ Repair/Remo::el <br />Valuation of Construction $ <br />••r. - - :. '• '" - PLAT PLAN REQUIREMENTS <br />°.j <br />Indicate lot size, name of streets, <br />-indicate location and width of <br />t _ i alleys, locate proposed and all <br />existing buildings, shoe distances <br />to property lines, show distances <br />between buildings. <br />aw , Lot size x <br />;•.- ` . Lot area Sa. Ft. <br />.Size of Bldg. So. Ft. <br />'j Number of Stories <br />1. Basement <br />'.r •` Signed By <br />For <br />Owner Phone 7 6.73 77cU <br />• DO NOT S']a ITS B'L OH THIS LI:7E-POR CITY_US Oii L'L . <br />Date received ( CCD ULe• Zone <br />Plan Check Number %S _'?)CI Fire Zone { <br />�, QCj - <br />Valuation .(� --� Occupancy Crcup � - <br />remit Fee Z. Type of Construction V_ <br />Plan Check Fee 3 Occupant Load <br />Total Fee Due � 7 � �� Dprinklers Required <br />Date Issued f ( d� 7 S_ __. • CITY - I <br />. • APPi�ElVEb� �OR'BI3ILDING PERMIT •' <br />