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BUILDING PERMIT APPLICATION <br />- _ <br />Applicant To Complete This Form - / le?x v UUOj� <br />_ <br />If more than one building is to be contructed, submit a separate permit applica-* <br />2iun for each building. A <br />separate permit will be issued for each building. <br />Owner Alec ti�rf� <br />G �� r�C�% Building Address <br />Address PD fin, <br />j r/ ) Lot_ 5 <br />_ Block <br />City 11�,¢[J <br />Phone -- Subdivision (Plat) <br />Architect/Engineer <br />2- <br />City <br />Phone Metes a Bounds (Unplatted) <br />Contractor r d !/nd/,•S <br />.. <br />✓ Sec. <br />Twp. Rye <br />_ <br />• <br />Address •.3/1Lry—/a� <br />/•,2 <br />City 1w�i.!/ <br />Phone -�-% �� Building Use 1 <br />Ale" <br />h!' <br />n��.L7 R. <br />State License Number <br />��, 3-(j/-/�,��7 Describe Work to Be Done /�/p b•� �''. <br />I <br />Expiration Date <br />SKETCH PLOT <br />PLAN BELOW' - <br />1 <br />Use of Building ' <br />[]New ❑ Addition EJ Repair/Remodel <br />• ' ! <br />Valuation of Construction <br />PLOT PLAN REQUIRE^SE, <br />.� <br />Indicate lot size, name of streets, <br />indicate location and width of <br />' alleys, locate proposed and all <br />i <br />_ <br />- <br />existing buildings, show distances <br />• <br />- - to property lines, show distances <br />• <br />- between buildings. <br />Lot size x <br />.. <br />' <br />t <br />Lot area Sq. Ft. <br />��- <br />s <br />!• <br />- Size of Bldg. Sc_. Ft. <br />- Number of stories <br />Basement <br />, <br />=• <br />Signed By <br />- i <br />For <br />- Owner Phone <br />DO NOT <br />[C:2 _*?L HSLOU THIS LINE -FOR CITY USE ONLY <br />Date S--ceived <br />Ace ZOn� <br />' <br />Plan Check Number <br />Fire Zone <br />Valuation <br />Occupancy Group <br />Permit fee <br />_ Type of Construction <br />Plan Check Fee <br />Occupant Load <br />Total Fee Die _ <br />Sprinklers Required <br />Date Issued <br />