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BUILDING PERMIT APPLIGA7TON <br />Applicant To Complete This Form <br />� `//� 5'�.' . <br />�/��7s <br />If more than one building is to be constructed, submit a separate permit <br />applica[ion for each building, A separate permit will be issued For each <br />building. _ � <br />c. � � c 1 �' � � ) <br />Owner����. A -L�ir���> Building Addrees C�'�)� °<��i�_ �� <br />c, /� � <br />Address�'(���C���('��1 �(��11'f' ��%. Lot .��� Block <br />(l �•� L� . <br />ciry( l�l�l,al�"� �oae��l-�^5d�sutaivision (Pta[) (I��-� ;'l�;�l�C'i.l,cV' �ic.��l�l��.� <br />Architect/Engineer ��� � <br />City <br />Phone � Metes & Bounds (Unplatte3) <br />Contra <br />Sec. Twp, _Range <br />State License Numbe{�.�(� /�7 ���Describe \Vork to be Done <br />Expiration Date �)-�Li �\� �._�Q 1f�(`, � � (�O^n� <br />-7� <br />SKETGH PLOT PLAN B�LON l� <br />Use ot <br />.� New ❑ Addition QRepair/Remodel <br />!�� , � r <br />Valuation of Construction S <br />YL(:T PLAN RES�UIREMENTS <br />Indicate lot aize, name of s[reets, <br />indicate loca[ion and width of alleys, <br />locate proposed and all e�isting <br />buildings, show distances to prop- <br />erty lines, show distances between <br />buildings, <br />Lot sizc x <br />Lot arca Sq. Ft, <br />Size of Bldg. Sq. Ft, <br />Number ot stories <br />Basement <br />Signed By_ Date <br />For <br />Owner Phone <br />DO NOT NRITE BLLON 'PHIS LINE -�';)R CITY USE ONLY <br />Date Reccived S/�j /%5 Uae Zone <br />—�—T— <br />Plan Check Number <br />r ��-� ^C�C� <br />Valuation 1 .. <br />Pcrmit Fee <br />�Z. �° ✓ <br />Firc Zone <br />Occupancy Group <br />Type ot Construction <br />Plan Check Fee Occupant Load <br />To[al Fee Due �Z � A� Sprinklcrs Required <br />Date Issued <br />