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BUILDING PERMIT APPLICATION <br />Applicant To Complete Thia Form <br />/�d3� <br />If more than one building ie to be conetructed, submit a separate permit �/3/7�T' <br />application for each building. A separate per it will be isaued for each <br />building. �UA LQ�iC � I <br />OwnerL il� f�i: �'��� •9 �� 1 �� Building Addreae � � a� � �� � I `� � d ��U� <br />Addreee a�34' i�i�9 ��ah � � LotdO-3o Bloek �5 3 �o.y ����d _ �hd <br />�. .�> � - 7'�sv (� � <br />City ��e ve l 1 Phone '; 7� l�a� Subdivieion (Plat) Gc�v �T re �� - a? <br />Architect/Engineer_ � Y VE 1�1H)J � U6�G (�i � 3�I� al.d��< �, I <br />City �L2 vL I I Phone M�:tee k Bounda (Unplatted) <br />ContraetorLaw�.e�cr (vq��,wc�-. See. Twp._Range <br />Addreae ��3a N��f� �n�, � <br />as._,� - tl i s c� /� <br />City ��r��"� pho¢e Building Uee �7oi �y���s, <br />c <br />State Liceaee Number Deaeribe Work to be <br />Expiration <br />�; SKETCH PLOT PLAN B�LOW <br />___ __ ._:__I __ . /� <br />-- Io7l ;st . I — Uee of Building fy�a� �'.,,�„� -c%� � <br />I �� �'�, I II New IIAddition�Repair/Remodel <br />I ; <br />� <br />� <br />C <br />{ <br />( <br />l <br />Valuation of Conetruction $ <br />PLOT PLAN RE(ZUIREMENTS <br />Indicate lo! eize, name of atreeta, <br />indieate location and width of alleys, <br />locate proposed and all exieting <br />buildinga, ehow disWnces to prop- <br />erty linee, ahow dietances betw�en <br />buildinga. <br />Lot size <br />Lot are <br />Size of Bidg, <br />Sq. Ft. <br />Sq. Ft. <br />Number of atories 3 �lnK-w�-�q ���"'^��� �I�� <br />A <br />IBaeement _ <br />- - �i Forg y�---- � � � � Date c� - � 3 - %5'_' <br />_ Si ned B <br />Owner Phon asa - Iyso i75'- 1�3 3 <br />I <br />Y <br />Date Received 2.'- « Uee <br />Plan Check Number%S-��.`j Fire Zone ' <br />Valuation <br />Permit �'ee <br />Plan Check Fe <br />Total Fec Due <br />Date Iesucd <br />Occupancy Gruup <br />Type of Construction <br />Occupant Load _ <br />Sprinklers Required <br />.� . , � -:''-�SF� <br />