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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more than one building is to be, constructed, submit a separate permit <br />• application for each building. A separate permit will be issued for each <br />building. <br />I?F6 9 <br />II''1 <br />Owner Building Address I ,7z4 FUL•-�L.�.`.r_ �ilV <br />Address otLT- lock_ �j`�it, `7 <br />City ..lrFi Phone 9 Subdivision (Plat)1C.Nou1 5 <br />Architect/Engineer <br />CityPhone Metes & Bounds (Unplatted) <br />Contractor Sec. Twp,_Range <br />City Phone <br />State License Number <br />Expiration Date <br />SKETCH PLOT PLAN BELOW <br />Building <br />Describe Work to be Done <br />Use of Building <br />f] New ❑ Addition []Repair/Remodel <br />�. <br />Valuation of Construction $ -L � <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of alleys, <br />locate proposed and all existing <br />buildings, show distances to prop- <br />erty lines, show distances between <br />buildings. <br />Lot size__7.3— x <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number of stories <br />Basement <br />Signed By Date <br />t, For <br />ner Phone _7% <br />DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY <br />Date Received Use Zone <br />Plan Check Number Fire Zone <br />Valuation <br />Permit Fee <br />Plan Check <br />Occupancy G <br />Type of Construe <br />Occupant Load <br />Total Fee Due Sprinklers Required <br />Date Issued <br />