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j ��I_ 1� <br /> � BUILDING PERMIT APPLICATION !1 5��� <br /> j Applicant To Complete This Form , <br /> , �; ,f����, <br /> If mare thar. one building is to he constructed, submit a separate permit ap , <br /> plication for each building. A separate permit will be is::ucd for each build- <br /> inq. <br /> Owner ��� � ��TDG/(TO/Y Building Addressf/b��/✓/v.��Q�d`¢ <br /> Address %/[7� •�LMw� �- Lot3-� -��k.;.Zt Sec. <br /> . <br /> City �� Phone:Z3` 63:1� 1'WP• Rqe. � <br /> Architect • Subdivision (Plat),��/¢�/.�, .�i�i1��r.�y ��` ' <br /> City Phone Metes & IIounds (Unplatted) <br /> Contractor ,Ap.���r� <br /> Address ��/r/ �.ry�td-2�y � � � <br /> /� 6S�-¢� <br /> CityL�2�� Phone �/ -9uilding Use ��Q/,ji� <br /> ,f'r.e{✓"C�x %L3jlYJ <br /> � � State License Number'2z 3-o/-�� Describe Work to IIe Done � <br /> ' a��.e .!'Lf�- <br /> Eapiration Date�i�_[�_ /��???/ eyI/rf/�G.e <br /> - Use of Building <br /> �� - '�Ne�a :_ Addition . Repair/Remodel <br /> � � Valnation of Constructi,on -$ 4-,�J�7, �„W <br /> � . � � � PLOT YLAN <br /> • Indicate lot size, name of streets, � <br /> . indicate location and width of <br /> alleys, locate proposed and all <br /> • existin9 buildin9s, show distances <br /> to property lines, show distances <br /> between buildings, j <br /> Lot size L2%x, x (3 ,3� <br /> ' � � � Lot area S.F. j <br /> � � Size of Dldg. S.E. I <br /> Number of Stories � <br /> IIasement <br /> Use 2on <br /> _ Signed -,o . �9' .� u�`eL �,� �`� <br /> j <br /> Fo � � <br /> ner <br /> DO NOT I�RITE BELOi� 4'fIIS LINfi-FOR CITY USE ONLY <br /> Date Received Fire Zone 3 <br /> Plan Check Nu ber Type of ConsLruction - ,Ci .- M..1 . <br /> Valualion � •�— Occupancy Group � <br /> r� � <br /> .Permit Pee `J, ,Y r �' U � Occupant Load , <br /> Plmi Check Fee Sprinklcrs Requised <br /> � Total Fee Due � � � . <br /> ' Permit Number � _ . � . <br /> DaL� Issued � . � <br /> APPROVED fOR BUILDING PERMIT � <br /> Dalr _ � <br />