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BUILDING PERMIT APPLICATION / � Q /�'� <br />, Applicant To Completc This ^orm ��� S <br />If more than one building is to be contructAd, submit a separate permit applica- <br />tion for each building. n separate permit •eill be issued `_or each 5uilding. <br />7 Owner �"L� c-�2�cP � ���� � C t� Building Address ,)=��(1'r tL- <br />Address ,�� / � L �+-r �� � l�f� . Lot_ G' ? Block � � <br />City �✓e r� 1� Phone I h• �`17G �ubdivisi.on (Plat) v<i � �_ 1? `� t" .�� <br />Architect/Engineer <br />City Phone lRetes fi Bovnds (Unplatted) <br />Contractor Sec. 'lWp. Rge <br />Address <br />City Phone Building Use t��c.�.F <br />State License Number Descri6e Work to Be Done _ � <br />Expiration oate _ � 1-3F'c�r�a'"i.�' `�- 1�"� ����M1+ <br />SRETCH YLOT PLAN BELOS9 — I <br />' Use of Building <br />. ❑ New ❑ Addition � Repair/Remodel <br />� Valuation of Construction $ <br />� , • PLOT PLAN REQUIREb1E:7TS . <br />• Indicate lot size, name o£ streets, <br />indicate location and �aidth of <br />alleys, locate proposed and al!. <br />existing buildinqs, show distances <br />� to property lines, show distances <br />�- " � between buildings. <br />Lot size X <br />� Lot area Sq. Ft. ' <br />� � Size of Bldg. Sq. Ft. � <br />•�� � Number of Stories � <br />� . 9asc.^..er.t '� <br />� ;�Signed By ��-� .�if�ccv � .�f0?/-�v�,�, � <br />' For � <br />Owncr Phone <br />DO NOT W2ITB BELOIV THIS LI:IE-FOR CITY USE 0:7LY �. <br />�.`_c ..:.�_c:•:,,:'. U�.e Zone - — <br />?'_.n C..cc:t •1cr-__ _ Fire Zonc � <br />Valuation Occuoancy Gzoua <br />I <br />Pemit Fee Type of Construction � - <br />Vlan Ched: Fee Occupant.Load <br />Sprinklcrs Required � <br />Total Fce Due . , <br />�at� Z„��a ciTv o� r-_vr_r��rT <br />APPRG"ED i G" f'�:�� -;��r f��",�,1� <br />Datc -----�'�-- ----- <br />