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� ' � Applicant Tu Cc�plete 'rnis :orm / ��/� I <br /> ' • 3�Y�s <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 /> J( Owner �.(/ �, � � Building Address �����{ d�cC�"• ' <br /> � Address Z,7'Z� r,c .� ti aot 3 � Gf siock yq'S� <br /> City ., -e � PhoneTifJl--l�f�� Subdivision (Plat) �i.p� p�%//� <br /> Architect/Engineer � <br /> City Phone Metes 6 Bounds (Unplatted) I <br /> Contractor Sec. 7top. Rge I <br /> Address ' <br /> � J ICity Phonc Building Use � 7�/x .�J�;,q <br /> State License Number Describe Work to Be Done e $�/, � <br /> Expiration Date �-E-,t. ELUS'/'�c �e � 7h� <br /> SRETCiI PLOT PLA:: [iEiO'v' J � �/ ,��`7 I <br /> -� . <br /> Use ot Building <br /> ' <br /> � • ❑New ❑ Addition �Repair/Rer„od� � <br /> � <br /> Valuation of Construction S ��� � <br /> _ . PLOT PIJ�C7 REQUIREt1E:ITS , � <br /> Indicate lot size, name oi streets, <br /> indicate location and width o: � <br /> alleys, locate proposed and a21 ' <br /> �� existing buildinqs, show distances ! <br /> • . to property lines, show distances <br /> betveen buildings. I <br /> Lot size x <br /> Lot area Sa. Ft. <br /> , � Size of Bldg. Sq. �t. <br /> Number of Stones <br /> �s 5 C.^..C::y!'J�—� <br /> \$1Cj71CCj 9}' � / <br /> For <br /> ' Owncr Pnone <br /> : DO NOT IiZITG H�iOIJ :HIS LI�E-FOR CITY USE O:ILY <br /> �_=r c�:c�3 �' ` L _7{ U_e �one - — <br /> 7'.an C.:cc% `1cr:__ Fire �one � <br /> Valuation Occupancy Group <br /> . Pemit Fec Type of Construction - _ <br /> � Plan Checl: Fee Occup�n[ Load <br /> � Total Fce Dce Sprinklcrs Required ' <br /> ' oatc tssur? CIfY i)' [VERETT <br /> f�F�f���0V'fEl f"C:� C"�I_DIf;G'PERf,'�� : <br /> ,. . <br />