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BUILDING PGRivtIT APPLICATION , / �:�J,' J/ <br /> Applicant To Comple[e This Form <br /> . ' . c�/'4/� .i <br /> If more than one building is fo be constructed, submit a separate permit � <br /> applieatioi: for each building. A separate permit will be issued for each � <br /> � building. � � <br /> ' Owaer.��?^/i�.,���-, � .�--'�n•�L�¢!' BuildingAddress � <br /> Address/�C��-� r /'�o��' << r'c% �6'cLotl- l,o. Block �Y <br /> n� � <br /> Gity ' '�:�.�: Phone Subdiviaion (Plat) i�✓�Lr _�2�•'-���- <br /> Architect/Engineer_ <br /> City Phone Metes & Bounds (Unplatted) <br /> Contractor�uc.+�'G=� �-!'-�ra� Sec.�.� Twp.�z� Range :j� - <br /> � � /� <br /> Address ��L� 3� f�v.a'��n1 d� t' <br /> � <br /> - City�-LL[.'--L' Phone ,.��s-/3�jBuilding Use <br /> � State License Numbey�23-�-/-��'�•��Describe �Vork to be Dooe /.rL2�i-�� ` /'-' �/"`�"� <br /> Er.piration Date — . <br /> SKETCH PLOT PLAN BL•'LO�V <br /> �`, �,_;� i���J S'� Use of Buildino• <br /> � � .II New CI Addition I�Repair/Remodel <br /> � �sy, 3�- <br /> � �,' ---���-� Valuation of Construction :� ✓�- <br /> c� E`�` <br /> � <br /> `___�� � - %PLOT PLAN REQUIREMENTS <br /> i <br /> \ Indicate lot size, name of s[reets, <br /> V { /��� � � indicate location and width oF alleys, <br /> �' J �� lcczte proposed and ali existing <br /> � . � -�-6`- }.uildings, show uistances to prop- <br /> � I� /� erty lines, shuw distances be[ween <br /> ,� �G� buildings. <br /> � � Lot size Y � � <br /> /� Lot area Sq. Ft. <br /> � Sizc of Bldg. Sq. Ft. <br /> -- � �'3 . ;; <br /> Numb�� of stories <br /> ��� - � Basement r- <br />� x<.M. v _ ,_ , . ' � Date � <br /> i� Signed By <br /> , u <br /> a <br /> so: � v� <br /> Owner Phone � � I <br /> W 'ry' <br /> DO NOT �VRITI"s SELOLN THIS LiNE - FOR CITY USE ONLY � � <br /> � - ^ <br /> � Date Received Use Zone U � L, <br /> '_ L�' <br /> Plan Check Number '�� - 1�-b Fire Zone r L \�I <br /> �� <br />�,�"`�^-�"':�' � ' Valuation_ J Jo Occupancy Group U � `�, <br /> � �'i <br /> Permit Fee Type of Censtruction p .� <br /> °= �1i <br /> Plan Check Fee Occupant Load d <br /> a - <br /> Q r <br /> � Total Fee Duc Sprinklers Required �: <br /> Date Issued <br /> �� <br />