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BUILDING PERMZT APPLICATION <br />Applicant To Complete This Fotm <br />z <br />����� <br />3���s <br />If more than one building is to be cunstructed, submit a separate permit a��- <br />plication for each building. A separate permit �aill be issued for each build- <br />in <br />9• � L <br />O�aner ��J , n Q l� cI� �, 4 r n T Building Address �i� �.Z Grq r� %� � V� <br />Address O��• /"q n�� � V Q Lot Blk. Sec.�_ <br />City /�rV 2/'Ca %r Phone�S� �&/O �,+p.� Rge. �S � <br />Architect <br />City Pha�e <br />Contractor <br />Address <br />City <br />State License Number' <br />Expiration Da <br />Phone <br />�� . <br />�- Subdivision (Plat) <br />Metes & IIounds (Unplatted) <br />Suilding Use <br />Describe Work to Be Done <br />�✓i/� �Ri—por� <br />Use of Building �9r �7 �e <br />O New - Addition Repair/Femodel <br />Valuation of Construction $ <br />PLOT PLI�N <br />Indicate lot size, name of streets, <br />indicat-c location and width of <br />alleys, locate proposed and all <br />existing buildin9s, show distances <br />to property lines, sho;e distances <br />between buildings. <br />LoL size �D d x� U� <br />�Lot area S•r• � <br />Size of IIld9. S.F. I <br />Numl�er of Stories <br />Sasement <br />Use Zone <br />Signed D � u �� <br />Fo: �5� — i �� v <br />Owner <br />DO NOT {4RITE DSLOW TIIIS LINC-FOR CITY USE ONLY <br />Date Received Fire 'Lone 3 <br />Plan Check NumUer � �-ia Type of Construction �/ -i�l <br />Valuation Z.�o o. `r='_ Occupancy Group f — <br />Permit Fee �Lo J� Occupant Load — <br />Plan Check Fee io. 4� Sprinklers Required_ <br />Total Pee Cue i � , .+�-c� <br />Permit Number __ _ � . � � <br />Date Issucd � <br />APPROV[D I"OR DUILDING PCRMIT <br />n,,., <br />