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BJILDING PERMIT APPLIGATION <br />Applicant To Complete This Form <br />If more than one builoing is to be constructed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />buildin �� <br />(�(�(� i /� <br />Owner i1�)D�� (�4�1`(1� Building Address��l� �P.(}>"'Q�4Cf� <br />(� ('� =� W I� L. � <br />Address^�1� !J�IQm"1�-1�4r�;�, _ Lo4 Q��i Block <br />�� '"p�. • � �� m �� <br />City(c��' hs�>.-x Phone — Subdivision(Plat)���� <br />Architect/Engineer <br />City � Phone Metes & Bounds (Unplatted) <br />Contracto (�i1,^.��_9�5--'.A�L Sec._Twp._Range <br />Address�'�"(1Gi � 1��i, �OfY� � (1�4'-� <br />Ci Phnn@��� � IIuilding Use <br />State License Number.��i.��l-�'��-�%`f�6 Describe Work [o be Done <br />G r <br />Er.piration Date ��- �)[� - ��l _ � n1� °� * 4��' `1: '�}1 i1�� -1� �y--- <br />SKETCH PL01' PLAN B�LON °`t 1�g��:;`(�'�11� 1-� <br />Use of Builaing <br />.Q New [7 Addition ,�Repair/Remodcl <br />OG <br />Valuation of Gonstruction S c�� �'i�� i <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of alleys, <br />locate proposed and all e�isting <br />buildings, show dis[ances [o prop- <br />erty lines, show distances Uetween <br />buildings. <br />Lot size �= <br />Lot area Sq. Ft. <br />Size ot Bldg. Sg. Ft. <br />Number of stories <br />Basement <br />SigIIed-&}� Date <br />For �__ �1� � �\���. �� tit. <br />Ownc; Phone, - 1 �� <br />DO NOT �VRITE BELOR' THIS LINE - FOR CITY USE ONLY <br />Date Receiv <br />Plan Gheck Numbc <br />r� 1^ �� <br />Valuation y�)��'Y`J � <br />Permit Fce VQ- � -- <br />Plan Check <br />Uee Zane <br />Fire 2one <br />Occupancy G <br />Type of Cons <br />Occupant Lo: <br />Z¢ e�' Sprinklers Required <br />Total Fee Duc � <br />Datc Iss <br />l =� C� c�cP. <br />