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� BUILDING PERMIT APPLICATION / � C� � � <br /> ; Applicant To Complete This Form j��//7 .,- <br /> If more than one building is to be constructed, submit a separate permit ap- <br /> plication for each building. A separate permit will be issucd for each build- <br /> ing. � . <br /> :� '/ � 7_� <br /> � Owner 'S n�1 � > $uilding Tddress �I7� y "PWfv�� L.l,'� F�E �� <br /> y� <br /> Address L �� -;� ! , Lot Blk. Sec. <br /> City�1/�- - �= I T Phone��.� -7-���, �p• Rge. ' . <br /> 9rchitect ;cUA�i=;� . Subdivision (Plat) <br /> City Phone Metes & Dounds (Ur.platted) <br /> Contractor G�rA��s�rn' `� 5Z7�v� � ��� �L�' d <br /> Address ' /'� �LTOti! S �ST �17� <br /> City Phone Building Use(-�'�=EA) H�-�'S�. -� �l�c�kSN-'f' <br /> � � State License Number' � � � Describe S4ork to Be Done� -!� A('C .�_ �'/'.� � !l��l:. <br /> ' Expiration Date �0��F `1 "'� �N�-- �-�=A�-� � <br /> ' (��� - - - - 4-7Lig' <br /> ����-" 1"�op � - ` � Use of Buildinq <br /> � , ; I '_New :. nddition k'Repair/Remodel <br /> � _ _�-- '; -- ------- <br /> � _ _ _ _ � I Valuation of Construction S /y CO„i� �;� <br /> � � � /`]T/�-�.il . <br /> � � � � �S T/Iv�c:. PIAT PLAN . <br /> C(1T� 1 C R i <br /> � j���� �.DIfvG , Indicate lot size, name of streets, <br /> i . indicate location and �ridth of <br /> � alleys, locate proposed and all <br /> , i � , _ ____ .: I ' existing buildings, show distances <br /> to property lines, show aistances <br /> ; � � � between buildings. <br /> ' � LoL sizc x � . I <br /> • � � � Lot area S.F. <br /> i � � . ' Size of Bld9,�� 1' / S.F. I <br /> NumUer cf Stories i; !t= � <br /> � IIasement_/L;nA� i= - ' <br /> I • ' Use Zone i <br /> ---��G�--- - I . Signed Dy / I I <br /> — - ~ � / . <br /> ��l/)t�� . _- --_ . �. For �l� � P � ���AOP�L- <br /> - Owner <br /> DO NOT WRI'PB DliLO[9 THIS LINE-FOR CIT! USE ONLY <br /> Date Received � �� � 7 5 Fire Zonc <br /> Plan Check Number � Type of Construction <br /> Valuation !5�� G�• �`� Occupancy Group <br /> Permit Fee /�`-i � Occupant Load . <br /> Plan Check Pee Sprinklers Requised <br /> Total Fee Duc /:S. 9U ' . <br /> Permit Number , <br /> Date Issued 3L?�7 S � <br /> 7—'T <br /> • APPROV[D FOR pUILDING PCRMIT � <br /> Date_ � <br />