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% %9/� <br /> , BUILDING FERMIT APPLICATION <br /> . Applicant To Complete This Form �Z��/�� <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 /> iny. , S" <br /> Owner�/I�S JEN�uE' �ztNNE2 Building Address2Vl/-�� ��%� <br /> Address �66d /V�RTH ►�rY��C J7"Z/U�' Lotr /`��1r� Blk. lo �,i Sec. <br /> City ��C2E� Phone Z"-'���.� Twp. Rge. <br /> 2lrchitect �'— - Subdivision (Plat) LUi REr� <br /> City � Phone � Metes 6 Bounds (Unplatted) <br /> Contractot /ZIU�R 5�ot' 1'ocr C� <br /> Address �.S' �= cCJn�N�� <br /> City C��c IZE7 Phone ��-''"�`l5� Building Lse <br /> State License Number �ZS-�Z"F�y� Describe SJork to Be Done :L ,usTAII <br /> . sxpiration Date C}c T 7 6 �/E� �r;,T �.�� /T �r t?oc � C•1 <br /> . • �")..� i ([e •�ta�c�i NC <br /> • � Use of Buildinq Buyn/t-u <br /> _New Addition Repair Femodel <br /> v <br /> • Valuation of Construction $ s�� <br /> � � PLOT PLAN <br /> Indicate lot size, name of stieets, <br /> indicate location and width of <br /> ' ' alleys, locate proposed and all <br /> ' existinq buildings, show distances <br /> to property lines, show i3istances <br /> • ' between buildings. <br /> Lot size x <br /> Lot area S.F. <br /> Size of Bldg. S.F. <br /> Number of Stories <br /> Basement <br /> � Use Zone <br /> ' . v <br /> _._ . . . -- - � . Signed By G� i.E�' <br /> For l�'E I�S!��. (Z�/ �U <br /> otiner <br /> DO NOT S9RITG BELOW THIS LIN�-COR CITY USE ONLY <br /> Date�Feceived � �� ^ Fire Zone <br /> Plan Check Number � Type of Construction <br /> Valu��ion .C-�t�7�0 • �� Occupancy Group <br /> Permit Fee 3 L-- ��' Occupant Load ' _ <br /> Plan ChecY. Fee �— � <br /> Sprinklezs Required <br /> ' Total Fee Uue j�� _ C� c� <br /> Yermit Number <br /> Datc Issued�7�� i �'( � � . • <br /> , APPR01(Ep FOR BUILDING PERMIT <br /> �... <br />