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BUILDING PERMIT APPLICATION / p <br />APPlicant To Complete This <br />corm <br />If more than one building is to be contructed, submit a separate permit <br />lion for eoa�cj�h��/h,uLildi aSa. <br />g- A�separr p•:rmit will be issued for each building, <br />\_�" <br />Over <br />_� <br />9�j e� Building Address .� C��� <br />Address <br />Block <br />city <br />Phone f 7 Subdibision (Plat) <br />Architect/Engineer <br />;,, •. <br />City <br />I ----�_ <br />Phone Metes s Bounds (Unplatted) <br />Contractor l7 <br />, <br />- <br />Sec._ <br />�. <br />Twp, Rge <br />Address <br />City <br />Phone Building Use t�f <br />State License Number �••^��'i •• <br />...v� <br />Describe Work to Be Done p t' <br />V- <br />I <br />Fzpiration Date <br />'� / .� <br />SKETCH PLOT <br />PL;LN BELOW <br />Use of Building <br />•.}. .. 1317ew ❑ Addition Repair/Remoa <br />L el <br />- <br />Valuation of Construction S 7 <br />"' <br />... <br />PLOT PLAN REQUIREMETITS _ <br />} <br />Indicate lot size, name of streets, <br />'indicate location and width of <br />alleys, locate proposed and all <br />t <br />_- -4 <br />existing buildings, show distances <br />! <br />to property lines, show distances <br />between buildings. <br />• <br />- Lot size x <br />. <br />' .... <br />s <br />rf <br />r' <br />. Lot area S <br />Size of Bldg, <br />: <br />So. Ft. <br />Number of Stories <br />Basement <br />(Signed By <br />'•_ <br />For <br />Owner Phone — y <br />a•Lu1'/ THI <br />Date `:cceived <br />Plan C:ieck Number <br />Valuation '0-7 <br />Pesnit Fee <br />Plan Check Fein _ <br />Total Fee Due <br />Date Issued <br />4E-i0R CITY USE ONLY <br />ULe Zone <br />Fire Zone <br />Occunancy Croup <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />c <br />