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BUILDING PERMIT APPLICATION � /� �J // . <br /> � Applicant To Gomplete Thie Form � <br /> . � If more than one building is to br constructed, avbmit a separate permit ��9�/ �7✓!� <br /> ' • application :or each building. A separate permit will be iesued for each � <br /> building. �. <br /> 1 / J� <br /> ��y <br /> k Owaer .;�:�R(;,!?„(�I.� �Lu;��a�'1G10.1't B '�ding Addresn .`�/IL� � �� <br /> � <br /> Addreea ��-�,� ��.'��K'�� ��✓�$d Lot .;0, � ; B}c�ck C'rS�i <br /> �3 � _ <br /> City �l':AY��<_ Phone �E,' �IQ�7 Snbdivision (Plat) i� G`�- �� �v�'�`�7 '� <br /> Arehitect/Engineer <br /> City Phone Metee & Bounde (Unplatted) . � <br /> Contractor �v��% Ri('I '��� n'�^T- Sea_Twp._Range <br /> Addrea8�l�-x � r <br /> City ��Nr�Y ��one �{"hl�Qn(,' BuildingUse � -rii�A�C=� - <br /> State Licenae Number "�.'J.�)-P�I -IZCCq Describe Work to be Done <br /> . Expiration Date I � "'. l.. ' n i' ,N k1 N � �,�Ctl7 <br /> SKETCH PLOT PLAN BELOW ' <br /> Uee of Building <br /> � New L7 Addition �]Repair/Remodel � <br /> r� <br /> . Yaluation of Cone[ruc[ion $ n7i%�% '—" <br /> PLOT PLAN R.EQUIREMENTS <br /> � Indicate lot eize, name of etreets, <br /> indicate location and width of alleys, <br /> � locate proposed and all existing <br /> � . buildinga, show dieWnces [o prop- <br /> � erty linea, show distances behveen <br /> buildings. � <br /> Lot nize X <br /> ' • Lot area Sq. Ft. <br /> �� Size of Sldg. Sq. Ft. <br /> Numher of etoriea <br /> Sasement <br /> . � � � � <br /> r Signed By�i r 1�� i'� 't�'t� Date �-�JG "'`j� � . <br /> . � <br /> For W <br /> 11. <br /> Owner Phone � � <br /> DO NOT WRITE BELOW TFIIS LINE - FOR CITY USE ONLY � � <br /> Q' -�y- 7�S W � <br /> � Date Received Uee Zone C -1 w � m <br /> . m ` <br /> Plan '�heck Numbcr1�� - � '�: Fire Zone Z �- C <br /> � � O <br /> Yaluation�OO � Occupancy Group .Y �- t <br /> � • F- � <br /> Permit Fee Q4, � �' Type of Conatruction V W <br /> > <br /> Occu ant Load � <br /> - Plan Check Fee_��$ �-O P � <br /> a <br /> Total Fee Due__�n� . {-O Sprinklera Required � � � <br /> 0 <br /> Datc Issued � <br />