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/ r'�/� <br /> . HUILDING PERMIT APPLICATION <br /> ApplicanC To Complete This Form �2�, �,� <br /> , if more than one building is to be constructed, submit a separate permit ap- <br /> plication for each building. A separate permit will be issued for each build- <br /> ing. , <br /> Owner��//�S �IEu�uE' o2E.�NER Building Address2U��"�° ���"�� <br /> Address �660 �JuR7K I�1$K 1�"�2/U�' Lotr /`1-�k� Blk. � ��i Sec. <br /> City �L E 2�7r Phone �-' ' _62/� Twp. Rge. <br /> � �— Subdivision (Ylat) L�E Rc"� <br /> F�rchitect <br /> City � Phone �- Metes 6 ➢ounds (Unplatted) <br /> Contractor �lucR Sr�c h'xr �O <br /> Address �.S' �= wniN�� <br /> City C UC RE7 Phonr '�-'"- �75U Building Use <br /> State License Number ZZ� �Z"'�'•y� Describe Work to Be Done �n�s"r�l� . <br /> Expization Date �}c? 7 � �(E� �ioT F°� � ��' �oc i= G� <br /> _ . �-�,,�T i R t � f�c. �c�i N! <br /> � - Use of Duilding BuSn/Ecs <br /> '__New Addition RepairJP.emodel <br /> �� <br /> � �, � Valuation of ConsCruction $ 5 ��,� �y`� <br /> � PLOT PLI�N <br /> � Indicate lot size, n�me of streets, <br /> � � indicate location and width oi <br /> - � � � alleys, locate propos�d and all <br /> � � - existing buildin9s, chow distances <br /> � - to property lines, show distances <br /> . ' between buildings. <br /> Lot size x <br /> Lot area S.F. <br /> Size of IIldg. S.F. <br /> � NumUer of Storics <br /> Sasement <br /> Usc 7.one <br /> . v' <br /> . � Signed Dy���_ �. G� �1' <br /> For �l1�LRS��c- (�C� = C�G <br /> owner <br /> DO NOT WRITE E3ELOW THIS LINL•'-FOR CITI' USG ONLY <br /> Uatc�Received �.� �� � Fire Zone <br /> Plan Clieck Number � � Type of Construction <br /> Valu��ion �[�-Z•O � �— Occnpancy Group <br /> Pcrmit Pee 3�� - `-��� Occupant Load . <br /> �� <br /> Plan Chec}; Pee SprinY.lcrs Required <br /> ' Total Fee Uue 2�Ln _ U c� <br /> YermiC Number ' <br /> Date Issued � 7 � I ��1 � � <br /> APPRU\(Ep FOR [3UILDIIVG PERAdIT <br /> Date�_pY <br />