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. <br />BUILDING PERMIT nPPLICATION / 9 O/ / <br />, Applicant To Complete This Foxm <br />If more than one building is to be constructed, submit a separate permit ap- 3/� �/'f <br />plication for each building. A separatc permit will be issued for each build- <br />ing. <br />:� <br />Owner J.� vrol� F� . 4-�r�n��r.; . <br />Address 11�5 YvS�r�vrr�c_ _ <br />City Foc���°_'\ t Phonez�z-zc���/ <br />Architect Cc�'Y�- � • . <br />City_F uc ti�-C� . Phone � <br />Contiactor C ��tiwt� <br />n ia.o�� ✓ <br />City ✓ Phone � <br />SL-ate License Number' �--=�-�-�-`—J <br />Expitation Date — -- <br />D�O NOT {VRITE DELO{9 <br />Date Received �__� - —�--- <br />Plan Check Humber <br />Valuation 5�(� � -�- <br />c9 � <br />Permzt Pce CJ � � <br />Plan Check Fee <br />Total Pce Due <br />Permit Number ' � <br />Date Issucd� 7� <br />IIuilding Address_ <br />Loti�rN �v Clk. <br />Twp. "_ Rye. <br />i rirac�rc,���- <br />Sec. <br />SuU3ivisicn (Plat) aNaNq�b��_�clln'�-s <br />Metes & IIounds (UnplatY.ed) <br />IIuilding <br />� <br />Describe WurY, to Be Done �,r��..qio-z. - <br />nL+��tcr(�i��v� - Qc.���C..��� r s6.i:,Cwtla� <br />0ti.'�a. L lG.i.l . : '�C, _. ' <br />Use of Building ;?:•,�,I v..�� e ��. <br />'— New -.-nddition Repair/Remodel�j <br />�__- _ <br />Valuation of Constructi,on $-2��� Sce`c <br />PLOT PLAN <br />Indicate lot size,.name of stree.ts, <br />indicate location and �aidth of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />betureer. buildings. <br />Lot size x <br />Lot lrea <br />� � Size of Bldc�. <br />Number of -ories <br />� IIasement / <br />llse �FLwie i P� <br />;c..Signed By <br />For <br />owner <br />SE ONLY <br />Fire Zone `� <br />Typc of Construction� <br />Occupancy Group <br />Occupant Load � <br />Sprinkler.s Required_ <br />APPROVEG fOR BUIt,DING PCRMIT <br />Date__ .. <br />.£. <br />