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BUILDING PERMIT APPLICATION <br />Applicant To Complete This :orm <br />' If more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. <br />Owner ( r'\-n vA r L IP TY-, 0-1'iZ6A% Building Address a 11 0 6 <br />' AddressLot ; Block <br />city Phone. Z; , Ct lJ subdivision (Plat) < i9 V R V <br />Architect/Engineer <br />• t .'`c'( city Phone Metes a Bounds (Unplatted) <br />1 . <br />Contractor <br />address <br />.Z <br />f City <br />y} State. License Number <br />;(. Lcpiration Date _ <br />Phone <br />Sec. Twp. Age <br />Building Use /!�e c •; ' ' <br />Describe Work to Be Done �- `•''`.. <br />SKETCH PLOT <br />PLAN BELOW <br />- <br />j <br />Ute of Building <br />IL <br />i <br />IDNew, Addition ❑ Repair/Remodel <br />i <br />Valuation of Construction $ <br />�. <br />.._. <br />PLOT PLAN REQUIF.E.RENTS <br />Indicate lot size, name of streets, <br />-indicate location and width of <br />alleys, locate proposed and all <br />existing building.:, show distances <br />.?2 <br />to property lines, show distances <br />between buildings. <br />Lot size x <br />..i- <br />• <br />- - .' <br />•- - ' <br />Lot area Sq. Ft. <br />_ - <br />Size of Bldg. Sq. Ft. <br />•i <br />:. <br />T— <br />Number of Stories <br />;. <br />Basement (1 <br />'� •, <br />Signed By M^! .... rt� • K, <br />For <br />Owner Phone <br />- <br />- DO NOT WRITE BELOW THIS <br />LINE -FOR CITY USE ONLY <br />-• •—. <br />Date Received 5/7j7S <br />Dce Zone <br />P1an.Check Number <br />7'5* — �//L `� <br />Fire Zone 3 <br />Valuation <br />Occuoancy Group <br />Pewit Fee <br />S <br />Type of Construction <br />Plan Check Fee <br />��- <br />Occupant Load <br />Total Fee Due <br />Sprinklers Required <br />CITY 0 <br />Date Issued <br />+^I <br />•APP.ROVED• FOR-BUR.DING PERMIT <br />�, <br />.Date _ F3y <br />