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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form, <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 />Owner �_ . lJ r vo �d Building Address 4i///YC;4au'0!%] � <br />Address i • 0 . Lo � 'C Y Block <br />City A U k i ti�f.o Phone 355-ISubdivision (Plat) <br />Architect/Engineer SA -VAC <br />City Phone <br />Contractor <br />DA' D�A, A , it <br />Address P. 0. Box 428 <br />fvluKilleo, as in on _ [�F3'7T— <br />City Phone <br />State License Number 203-el- /- /.2S/O <br />Expiration Date <br />f SKETCH PLOT PLAN BELOW <br />Metes 5 Bounds (Unplatted) <br />Sec. Twp. Rge <br />_rf 2S <br />Building Use s�1� <br />Describe <br />Work to Be Done <br />Use of Building <br />ffdNew ❑ Addition ❑ Repair/Remodel <br />Valuation of Construction <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings,.show distances <br />to property lines, show distances <br />between buildings. <br />Lot size i.V, x ;Af4- <br />Lot area /L, Soo Sq. Ft. <br />Size of Bldg. AMW q; q Sq. Ft. <br />Number of Stories <br />Basements n <br />Signed By 1V_LiUO i� l RII4111)/Q <br />For 't Qu' d / Ax-6r'/2 <br />Owner Phone <br />DO NOT WRITE BELOW THIS LINE -FOR CITY USE ONLY <br />Date Seceived ��� %� ULe Zone <br />Plan Check Number Fire Zone <br />Valuation <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Date Issued <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />I <br />