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. , <br />-• ., ! _ � � SUII,DING PERMIT APPLICATION � ' � '•��i - <br />' .. . � � . � llpplicant To Complete This : orm ��.� � <br />. � /.� a�. :'i <br />� I! more than one buildinq is t� be contructed, submit a separate permit applica- . <br />�. tion for each buildinq.. .1 separate permit will be issued foz each building. <br />• . � Orner `�„t�" ./ (� .� <br />� "" � / Suildinq Address ntt.+z��. <br />llddress � ' D G �,, ,� yot // <br />L 81ock .� • <br />City / . , Phone 3T3-S'1i S� Subdivision (Plat) �_,,.E_�� .�� : <br />1=Chitect/Engineer <br />"`s Phone <br />Contractor � !��. ,,.,,��.�% �!x;,� — <br />�. � <br />�3dress �� �;�• �r <br />�tY � ��-e-G� Phone 33 7- yy s L <br />State. License Ni:mber 1 z 3- v i- <br />Ezpiration Dat� <br />SICETCH PLOT PI.AN BEL0t�1' <br />. <br />'� ' . , .... . <br />(� , ,iLtn_.. .: �cC..�,tq,f-�f,U . . <br />��,t � �� /,� � <br />/ �'�� -li. �l.�-iti_G� <br />in'il'-.�-li% `hC�/ti' /.CJF,('-'''t� .•. <br />`/ _. fi�e�..✓.' . • . _ <br />� ' - <br />� ... � <br />�' .:. - <br />' � <br />. .: . j <br />,-.. _ <br />• � ., -•- <br />i, <br />Date ?;eceived <br />a <br />tietes t Hounds (Unplatted) <br />Sec. Twp. Rge ' <br />Building Use ��=-����" , ' <br />. .• •.� <br />Describe Work to Be Done ������'� <br />:�`-� �t -� u,. �s.,G'� �. . <br />. i <br />i _ <br />Ose of Building • <br />�Nev ❑ Additi � <br />❑ Repair/Remo:Iel <br />7aluation of Construction $ �vc f--- �' <br />. . PIAT PLAN REQUIRE,�Iy.yTS , <br />Iadicate lot size, name of streets, <br />indicate location and width o� <br />allcys, locate proposed a.d all <br />existing buildi :gs, sho:o distances <br />• to property lines, show distances <br />between buildings. <br />� Lot size X <br />. Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />' Number of Storles <br />Basement <br />Sigaed By �: _ � ��� <br />i ✓ <br />For _ <br />Owner Phone <br />Z <br />' � --- <br />Ute 3one <br />Plan C:iec;: yur.Ser � <br />Valua:ion � � � �-v <br />Pem.{t Fee 2� �G <br />Ylan Check Fee —�'-- <br />OV <br />1bta1 Fee Due � �� -�� <br />Date Issued �� <br />Fire Zone <br />Occuaancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />