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' IIUILDING PERMIT APPLICATZON / (� � �/ �•�� <br />. Ap�licant To Complete This ^orm " <br />/� a%��7� <br />� If more than one buildinq is to be contructed, submit a separate permit a�lidaf <br />. tion for each buildinq. A separate permit will be issued for each building. �, <br />� � Owner � �_ Building Address (p��..��'�)1.!�; vc�j <br />Address ,�GQ ��r � / Lo•t Block � <br />. City Phone � � �� .LSuk�division (Plat) <br />�� Architect/Engineer • <br />City Phone Hates s Bounds (Unplatted) <br />, Contractor�iy�r �!/���Q,{� �j,�y JC�.�� ��(J[J.�� Rge �_� <br />Addres� �Q J �.7�%� ��,�%/ 1 � � ��� ' <br />9 � • � <br />City�i�%�'�/1.� Phone �j �'� � Building Dse ' <br />�� State License Numbe j.J� ��� Describe Work to IIe Done �,' <br />�+7� �� � . y- <br />. Expiration Date / � -/ �Nt�d�f' <br />. . i .f / .� . ! .. .. . . <br />� <br />•i <br />SKETCH PLOT PLAN BELGIP <br />a <br />Dse of <br />9 <br />� �New ❑ Addition �Repair/Remodel <br />" Valuation of Construction $�.� 7 a, �%(J <br />•� PIAT PLAN REQUIREh1ENTS _ <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />eT:isting buildings, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size x <br />. Lot area Sq. Ft. <br />.. • Size of Bldg. Sq. Ft. <br />Number of Stories <br />Baseme�t <br />Signed By � <br />Por ' <br />Owner Phone <br />DO `70^_ S•::I3: 3=LQ[9 T!iIS LI�ii:•�rOR CITY USF. 0.7LY <br />Date :^.aceived Uce �one <br />Plan C: ec�: :dcr��er <br />Valuatio� <br />Pernit Fee <br />Plan Checl: Fee <br />Total Fee Due _ <br />Datc Issue3 <br />Fire Zone <br />Occuoancy Group _ <br />Type o£ Construction <br />Occupant Load <br />Sprinklers Required <br />