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- / i 9/9 <br /> BUILDING PERMIT APPLICAT20N <br /> � Applicant To Complete This Form � , /,� �,� <br /> .•y. <br /> ,, If more than one building is to be constructed, submit a separate permit ap- <br /> plication for each building. A separate permit �aill be issue ZfO��ach build- <br /> inq. . � <br /> � <br /> Owner��S JENn/b' �2£NNE"2 Building Address2��1/-/� ���' <br /> Address /66d No2TN �rY�K �"�iu�� Lor� /y/�-' Bik. � �3 seo. <br /> City ��c lLE7r Phone Z"'-�2/� Twp. Rge. <br /> � Architect �- - Subdivision (Plat) �UE �� <br /> City � Phone '� Metes & Bounds (Unplatted) <br /> Contractor�luER S�oC 1?acF CO <br /> Address i5= z u�niN�� <br /> City CL�C 'nE7 Phone ��-'""�7� Building Use <br /> State License Number ZZS'Oi^f�:y� Describe Flork to Be Done ..��Lsr�fl .. <br /> Expiration Date �}c"r 7 � A(� N'�T �" � �'� �°` �� G� <br /> . �-�"f i R r 13 c./c%N! <br /> , ._ Use of Building L3us�/Ev <br /> � �New . Addition Repair Femodel <br /> � Valuation of Construction S S�� <br /> • PLOT PLAN <br /> � • Sndicate lot size, name of atreete, <br /> indicate location and width of <br /> • alleys, locate proposed and all <br /> ' existing buildings, show distancea <br /> to property lines, show i3istances <br /> • between buildings. <br /> � - Lot size X <br /> � � - � Lot area S• • <br /> Size of 8 dg. S.F. <br /> Number of Stories <br /> � ' Basement <br /> • Use Zone <br /> � Signed By ��'' <br /> - � � For /t 1�E I�S!or �C� C�_ <br /> Ormer <br /> DO NOT {4RITE BGLOW TNIS LINH-FOR CITY USE ONLY <br /> Date�Received �� � Fire Zone <br /> Plan Check Number � Type of Construction <br /> � Valu3tion Ci�Z� '�— Occupancy Group <br /> � Permit Fee 3G�- �e� Oceupant Load � .� <br /> Ylan Check Fee —� Sprinklers Required <br /> � Total Fee Due �jL -c+ U . <br /> ' Permit Number . � <br /> � Date Issued ��I!�Z 1 � ' � � <br /> , <br /> , APPRO�EQ FOR E3UILDING PERMIT. <br /> Date�_gY <br />