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BUILDING PERMIT APPLICATION <br />ApplicanL• To Complete This Form <br />If more than one building is to bc constructed, submit a separate permit ap- <br />plication £or ear,h building. n separate permit will be issued for each build- <br />ing. <br />,ti <br />Owner �/ � �_h' ^, j, �•f..:. ; Duilding Address � <br />Address_ ,SQy /� •Gt � n o' Lot in_ 1- 7 Hlk._'�`}'-( ., Sec. <br />City �- v. r�=� 77 Phone �.� __'.� i Twp. Rge. <br />Architect <br />city, <br />Phone <br />Contractor S7";, .�:0 1/ L �t �y� �� r-� <br />Address �J ?_."'u ,Y r-, a. � , <br />V <br />City J� y' r� -� Phone.�� � <br />State License Number' ��s' ' U 1' 8d+ a m <br />Eapiration Date /a - 7 � <br />t "_-�r0, �T-�� <br />Subdivision (Ylat) <br />Mei:es & Bounds (Unplcitted) <br />Building Use <br />Describe t9ork to De Done F� x S7�_,r�,�: <br />� � �' .�,II � <br />tSH� I. deck � i,,.":_li ,,=�� i: <br />Use of Building <br />'— New _. Tddition . Repair/Femodel <br />Valuation oL Construction $`i'L�O,Op <br />PLOT PL1W <br />IndicaLe lot size, nane of ctreets, <br />indicat-e location and width of <br />alleys, locate proposed and all <br />existing buildinys, show distances <br />to property lines, show distances <br />between buildings. , <br />Lot size _S � x /, ) � <br />� �Lot area S.F. <br />' Size of Dldg. S,F, <br />Number of Stories <br />Basement <br />Use Zone / <br />�,i_ _:J.�l"�-_ . <br />Signed'By�� `..,..-. �-i� ---- <br />� �- �� <br />For �'i� r_/i -'. Rf�io::• :-c : / <br />Owner � <br />DO NOT IJRITE DELOI9 TIIIS LINE-FOR CITY USE ONLY <br />Date Received �, -/ j-� � Fire Zone <br />Plan Check Number � _ Type of Construction <br />Valuation Occupancy Group <br />Permit Fce <br />Plan Check <br />Total Fee Due <br />Pcrmit Numner � <br />Uate Issued � <br />Occupant <br />Sprinklers Required <br />APPROVED FOR QUILDIh�G PERMIT <br />n.,�,. <br />