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<br />BUILDING PEItMIT APPIdCATION
<br />Applicant To Complete Thia Form
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<br />If more than onc building is to be conetructed, nubmit a eepa.rat� permit .�i%t' �>
<br />ipplica[ion for each t�ldir.b• A au�.arate permit will be iasued for each
<br />building. . , -
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<br />Owner �tt\. 1= JER��,I C�Y- t r' �y� O�.�' -
<br />. � 4\ . �Et:ildiag Addresa �...i� ;�.� '�.�\� '�i�. �,',��:.�;` � ���,..,
<br />Addreee �`��� LC�-�}�, 1u t _
<br />Lot').H'�•cti;-Bloek �� •
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<br />Ci \ tY_ Phone^-`i1, L\�,A. . ,.''1_�' `_,_"'°_,�_1•�.
<br />�— { Subdivieion (Plat) ����qp�, �c`� r,. \'�,i \��iri;`.1.
<br />Arthitect/Engineer�lC.i1E1�1_ �� ����F���,�����t'
<br />City �-1'I=F�1=� Phone�%�`i\- j13�„ ��—
<br />l\ Metee & Bounds (Unplatted) � '
<br />Contractor_.nl�i�'Ci'.D ���t>>r..1�i �1 �� .
<br />��_ See. Twp,,�_Range
<br />Addreae ~`�h`� �F_�MG��c \,�'[__ .
<br />City L\'eP,1=�� Phone '�b� - 9, —
<br />�—. � ��\°i Building Uae_��,S�Kf��t�,C - `�_���-� �
<br />State,Idcease Num6er�bFi''��^,�-q� �
<br />�'_ l�`l _ Deseribe Work to be Dane t-1t�(���
<br />ExpiraHon Date ��� ��,'�.y - . �
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<br />SKETCH PLOT PLqD7gELOW
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<br />LOLV
<br />Date Re;e
<br />Plaa Cheak Number
<br />Va.uation /'�j �(�+Ln CQr=
<br />Permit Pee_ � (pQ �
<br />Plan Check Fe.e � .
<br />Total Fee Due__
<br />Date Ieeued � �
<br />� �U�r oF Building
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<br />'��IINew =[Addition 'LiRepair/Remodel
<br />' Valuatio¢ of Gonstruction S ��'S LCf �''
<br />� PLOT PLpN gEQ[7��TtiENTg ��
<br />Indieate lot size, name of stree[s,
<br />indieate location and w;d[h of a.l.ieys,
<br />locate proposed and all existing
<br />buildings, show distances to prop-
<br />4rty lioes, show distances be•tween
<br />buildiaga,
<br />Lot nize�'_� `1q`:l
<br />I.ot area Sq, Ft.
<br />Size of Bidg, Sq. F,�.
<br />Number of stories
<br />� Baueme¢t .-
<br />Signed By 5� L4_ -\ �1�r' ' Date �4 l< <� .
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<br />sor � �l;�= \ v�.F,c.� tl c�1-;�,,..�
<br />�Owne: Phone •�-.�`�,�_
<br />S LiNF. _ c`nn r.m.. .-.._ ____
<br />Use Zone
<br />Firc Zoae
<br />Oeeupancp Group
<br />Type of Construction
<br />Oeeupant Load CITY Gi EVLk[ (1
<br />�FPl7l'NEU-F17�'�UILCING PCRIvi
<br />Sprieiklere Fequired
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