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- -- -- -- - - - - - . . . . _.. . .- -- - - - - - - � --- - ____. . „_.. <br />BUZLDING PERMIT APPLICATION / U " �'�..•� <br />Applicant To Complete This ^orm // /d��/� <br />0 / <br />. If more than one building is to be contructed, s�:bmit a separate permit applica- <br />tion for each buildinq. e1 separate permit wi11 be issued for ear.h building. <br />Owner � ''��a f" %�crv z y Building Address 35- I,� �z �c rn 6a r cj <br />Address 3 S� f��� �` ,,.' b �.-�i Lot � 3`+ 3` y Block �--=r-�=-- �f --�~'(o <br />City � u e r e er phone <br />Architect/Engineer <br />City <br />Contractor <br />_Phone <br />�.�.��•.r� ���iTr. �c <br />a3dress r3 o x �,o�.� � � <br />City ��zr�ct Phone 33'7 -`� x z 2' <br />State License Number ��-3 — ��- � 8 � 1 <br />Expiration Date <br />SICETCH PLOT PLAN BELOW <br />j'�e �.�C ��r. ���j'c�cn <br />SZzr�-w Shze- <br />� G:o c J¢. W n � V� s c o. T. . <br />Shte.t'reel- �.. �Pe.� . <br />_ Q�c,ne.��n� d�e-rt1e� <br />� i v. R c o� 1� <br />1��` Ye'cv�ew' <br />C L i f� n C� - .. <br />��e�T.-;c.�4 V'�pciir � <br />a '� <br />(���ec �.' �e' <br />Nc•: .S�'r✓�tu,-al d.nw.Q.��. <br />C.:. � \ <br />- , , - �u � e.s � cG e r+ � -C ) <br />J <br />���� ��y <br />/ � <br />Subdivision (Plzt) Plnt c F ��e.z�} : <br />ui✓. r� <br />Metes fi Bounds (Unplatted) <br />See. Twp. Rge <br />Huilding Use ��� f! � � <br />Describe Work to IIe Done F�y�� � <br />..V4i�9fL (L2-lIQ I V'5 <br />Dse of Building <br />❑ New ❑ Addition � Repair/Remodel <br />Valuation of Coi�struction $ � z°'` °-1 <br />PLOT PLAN REQUIREFfENTS <br />Indicate lot size, name of streets, <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 sf ze x <br />Lot area Sq. Ft. <br />� Size of Bldg. Sq. Ft. <br />Number of Sto�ies <br />9asement <br />Signed 5y x � ��-�'—�^-->-� <br />i <br />For /Y7/�'-1ti���c� �G�vSTiP. Cc. <br />Oc.�ner Phone <br />DO NOT WRITE BELOtJ THIS LINE-FOR CITY ❑SE Oi7LY <br />Dzte .'xei•:ed (��—�— 7��� U_e Zone <br />Plan Chec:r :�urbe� <br />Valuation � ,� �CJ�o _ <br />^ o� <br />Pemit Fee � � � <br />Plan Checl: Fee <br />Total Pee Dce <br />Datc Issued <br />Fire Zone <br />Occuozncy Group _ <br />Type of Construction <br />Occupant Load <br />Sori.n'r,lers Required <br />�, P�.u.e�c,�� � �' � 8h�—�'�-- <br />