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. : - <br /> • � 1 � � - BUZLDING PERMIT APPLICATION ,�f�--� � !���'j <br /> -• � Ilpplicant To Complete This :orm , / .�' �' <br /> , . , ����,, .. <br /> ' if mcre than one buildinq is to be contructed, submit a sepazate permit applica-� <br /> . . tion for each building. �1 separate permit will be issued for each building. <br /> ' � Ovner �/L �i���,�/,�i��< .� /, 7 5i, �, Suilding Address > .� � �` ,��l.�c,.��� ;. . � <br /> � Iddress � > >�� � /�'c'. �-1 i� Lot �� �' Block �7 J `"� ' <br /> • � '�' Subdi4ision (Piat) <br /> City G C [ >'/ �� Phone,i:I ���3: . , ' <br /> ` - l,rchitect�Engineer � � � ' �%� �'� ' "� �� � � ' <br /> '"� City Phone Metes e Bounds (Unplatted) <br /> . _ . =j <br /> . � :,� Contractor ''L�<-`�L /o� S � Sec. Twp. A4e <br /> ` . 1Sddress � <br /> - - �— � <br /> ' City Phone Building Use 'b -�� <br /> � �-�� State License Ncaber Describe Work to Be Done ��.�� � <br /> � .i Expiration Dat� i'�- �i �, ( . .jr" / c / �' t <br /> •� ' - � SRETCH PLOT PLAt7 IIELOI4� • � <br /> 1 , IIse of Building <br /> � � . . <br /> � � � � �. � � . . .' , � �. . . , . []11ew ❑ Addition ❑ Repair/Remo�el � <br /> _ . . .. . • j_ �[: . <br /> ' • . � . . : . � , Valuation of Cor.struction $ >�� � <br /> " � � � � ' � PLOT PI.F1N REQUIRE�L:7TS . . � <br /> -....• . � . � � - <br /> � • . � ' ' Indicate lot size, name of streets, <br /> � -� �I . • ' �indicate location anc width of <br /> . j � ' � . �. � - alleps, locate aroposed and all - <br /> - :�'j ' ' � � , , existing buildi.-.gs, sno•d distances <br /> � : •� - . _ -� •- •u : . . . � i � to property lines, show distances <br /> - ' � .��� \\ betaeen buildings. <br /> ' ' . . . v� ��� <br /> � � . ` � �Lot size x <br /> ' ,,,- + ' I . Lot azea Sq. Ft. <br /> Size of Bldg. Sa. Ft. <br /> a ; '" �� � . �� � Number of Stories <br /> . ;' ' , ' IIasement <br /> ,:. - � � , �.. . <br /> .� . —' � Signed BY�-, . �c-�• . C l ,i'C`. ,_� . <br /> i ( <br /> � For/j�. 1//� /iii��/%�:/.'t: ✓�S�/ ,li ,�., ' <br /> � � Owncr Phone/ <br /> � DO :70'" S{Z?TL' Bs'.LO(] THI� LZ.d'r:-POR CZTY USB O27L'! <br /> /. ' ' � <br /> nate ��ceived � %/ �7 1 Uce zonr <br /> ' Plan Check :lu..-.Ser � ' Fire 2onc <br /> Valuation `-��' Occuoancy Grou� <br /> ' • � .h`�-.c:.. <br /> Pemit Fee S • Type of Construction <br /> Plan Check Fee Occupant Load <br /> , 2bta1 Fee Due J• � Sprinklers Required <br /> oat� i5su�a •Cc �7 7J� " ' : . - <br />