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-� ' • BUILDING PER�SIT AFPLIC%�TION / ry <br />.. ' Applicant To Completc 'Phis ^orm J �jS '• <br />� <br />Zf more than one building is to be contructed, submit a se arate /,/z / <br />� tion for each building. A se arate. p Permit applica- 'i <br />/ P permit will bc issued £or each building. <br />- � Owner �71�� Hu�dinq Address %�i / /�iq /�[��-ND �i� <br />Address �9 1 ��G <br />' Lo Block �O � <br />City Sr i+i7Z.� Phone <br />---�__ Subdivision (Plat) ai��r��L/ �j}w� ; <br />e <br />Archatect/Engineer <br />� City Phon= Metes s Bounds (Unplatted) <br />, Contractor Y> fiA S�2b"rc,_ <o <br />---�_ Sec. Twp. Rge <br />Address /S`3�-2� 3 i'� sa�l <br />City,^.�o�Rw:+� �Iy}N�� phone 7 J 4-� S y � Buil3ing Use <br />;� State License Number �Z2 3 r�/ i 3�$�3 Describe Work to IIe Done � <br />Expiration Date 1- r' �, �= <br />.,'%-/- 7 k p�;n� �'N,= %iJi� ,S;^-E'�:,�, <br />0 <br />SRETCH PLOT PLAP] BELOW� <br />DO :IC: ;:3i.� �LOii <br />Date �^.eceived %� � Z2��] � <br />Plan Chec}: Sunbor <br />4'aivatio.; <br />Perciit Fee <br />Plan Check Fee <br />Total Fee Due <br />Datc Issued <br />Ose of Bui.lding • <br />�New ❑ Addition �Repair/Remodel <br />Valuation of Construction $'Z 2 8 5 � <br />PIA: PLAN REQUIREh1ENTS <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate nroposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size X <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Nu•ibcr of Stories <br />Be.sement <br />Siyned By ,���.,...��a,»..,�� <br />r�r /YLl7 <br />Owncr Phone � 7y-b� p^ <br />LI`!E <br />U�e Zone <br />Fire Zonc <br />OIIL'f <br />Occuoancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />o�� � ��G <br />