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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <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. n <br />Owner /�,Q- E/Y Fb ��fl(� Building Address 3 01 iV4.j)t� SDn/ <br />Address ll :}D'15 -( Lot Blk. Sec. <br />City✓17R TF Phone S �•�-3 Zj Twp. Rge. <br />Architect _— Subdivision (Plat) <br />City Phone - Metes & Bounds (Unplatted) <br />Contractor ZS ^ d s <br />Address' <br />City Phone Building Use <br />State License Number Describe Work to Be Done�r- <br />Expiration Date OWL)A-P, S14KC-9 <br />Date -Received 1? I LO1-1 \ <br />Plan Check Number <br />Valudtion ( obb- e"' <br />Permit Fee IC) <br />Plan Check Fee <br />Total Fee Due O <br />Permit Number <br />Date issued 1 *2-1 0 'jam <br />APPROVED FOR 1UILDING PERMIT <br />Date.By. <br />Use of Building <br />:--New - Addition -Repair/Remodel <br />Valuation of Construction $-40AS 00 <br />PLOT PLAN <br />Indicate lot size, name of stracts, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size x <br />Lot area S.F. <br />Size of Bldg. S.F. <br />Number of Stories <br />Basement <br />Use Zone <br />Signed By _ <br />for Q7 <br />Owner <br />Fire Zone <br />Type of Construction <br />Occupancy Group <br />occupant Load <br />Sprinklers Required <br />r _ - <br />