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---- -- - - - - - . -- -- -- -- - - �--- - -.._.. .- <br />BUILDING PERMIT AFPLICATION / C/ K' `� "" ����'))) <br />Ap�l'�ant To Complete This ^orm ��/�/��/ <br />/ <br />If more than one building is to Ue contructed, submit a separate permit applica- <br />tion for each buildinq. el separate permit will bc issued for each building. <br />Owner �, �� /.,� Building Address � � � � � f�'.'� �� �- %. J� ,% <br />Address ��%r'! �� Lot Block <br />City _ Phone _ Subdivision (Plat) � <br />Architect/Engineer <br />Ci.ty Phone Metes 6 Bounds (Unplatted) <br />Conttactor ���'�l)9�G� ,l% ��?��f��/��.��ec. Twp. Rge <br />Address �'7D �7--� �!`i��� �'J � ' <br />City � yi1/(d0U%� Phone '/�/ 3 S� ���suilding Us� �E� j/ 1�) �%JC�'- <br />State License Number 2��-b �- �/q�tr Describe Work to Be Done <br />9 � � ,..,., � �-=` a <br />Expiration nate � � 7� ,..� C� L � j��- �- L S <br />� . , <br />SKETCH PLOT PLAN HELOW <br />e ? <br />Date -.^.aceivcd ��r"!' � <br />Plan Chect: Vurber <br />Valuation (��� �T'Sj A6 <br />Pemit Fee <br />Plan Checl: Fee <br />Total Fee Due <br />Datc Issue3 <br />Use of Building <br />❑ New ❑ Addition ❑ Repair/Remodel <br />Valuation of Construction $ <br />PLOT PLAN Rx'QUIREI�SEYTS <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate pronosed and all <br />existing 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 />Baserent �, <br />] , / ; �— <br />Signed /y��/ � ' ��L� � ;� <br />g ;. r <br />For /! iJ�l�, <br />Owner Phone <br />U�e Zone <br />Fire Zonc <br />Occuoancy Grouo __ <br />Type of Construction <br />Occupant Load . <br />, <br />e <br />_ Sprinklers Reauired <br />— APPF�;_CITI' 0,-. �,;...,__. _ <br />�C17 ('�;I` r .. <br />i <br />�" �� . <br />�, �. ' �_1�. � f-�R,��ir <br />t� ,�..� <br />i <br />� <br />