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BUILDING PERMIT APPLICATION <br /> Applicant To Complete This Form � � —� <br /> � � <br /> � If more than one building is to be constructed, submit a separate permit /� � � <br /> • application for each building. A separate permit will be issued for each �'/5�i� <br /> building. <br /> / )� <br /> Owneb, l v��r: I '� i I � �`, �'�'�1 '�i'l� Building Address �- � I-� 'ti}�� 7� / <br /> . - :� � —' , � . <br /> r <br /> i � - c� <br /> _�ddress�:7��� :; - -�:..1;")(l i.��_�J Lot�_Block�� � — Q -�',�O . <br /> ( n . <br /> City T'�I�C�I`.��i�� Phone"�!'�'-_=��.:'; Subdivisinn (Plat)_ �p. �,^yt�r �..ts1�0_nG� �'w � . <br /> Architect/Engineer �\ <br /> City � Phone �\ Metes & Bounds (Unplatted)_ <br /> � �i ) <br /> 'ti Contractor�)ll�.���. �n. �.1/;(-'7�i' ��._� Sec._Twp._Range <br /> Address� -(� . ��(�nn�1�'�'n �I�� r <br /> ` — <br /> City�� �- �:� ��`�.� Phone����� .�)� 3uilding Use <br /> State License Nu.nLer-]��=?a����-/;`/���" UescriSe Work to be Done t }1 �.1f:C'�-! <br /> . Expiration Date �i� �;i(��� l ���� _ � � ��I <br /> SKETCH PLOT PLAN BCLO�V . <br /> � Use of 3uilding <br /> .I� Ne•N Q Addition ��epair/Remodcl <br /> ValuaCion of Construction 5 �; ��� _ <br /> PLOT PL.AN REQUTAEM�NTS <br /> Indica!e lot size, name of streets, <br /> indicate location and �vidth of allcys, <br /> � loca[c proposed and all existing <br /> buildings, show distances to prop- <br /> erty lines, �how distances bctwcen <br /> buildings, <br /> Lot aize x <br /> ' Lot arca Sq. Ft. <br /> Size of Bldg. Sq. Ft. <br /> Number of stories <br /> Rasement <br /> . �_\Sign^�d ' Date <br /> � � For�S(�� �r-�..1_�;-� — <br /> Owner hone <br /> DO NOT WRITE BL• LOW THIS LINE - FOR CITY USE ONLY <br /> DateReceived �-5'�S Use 'Lone <br /> Plan Check Number Fire Zone ' <br /> Valuation �Vr CY� Occupancy Group <br /> Permit Fee �i'�/' Type o[ Construction <br /> Plan Check Fee Occupant Load <br /> Total Fee Due Sprinklcrs Required <br /> Datc Issued <br />