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BUILDING PERMIT APPLICATION <br />Applicant To Compiete This Form <br />If more than one building is to be constructed, submit a aeparate permit <br />applieation for each building. A separate permit will be issued for each <br />.......�... � Z.' . <br />Owaer C. Bui�ding Address��y�1� � RA A.� .� <br />^s� n C;J'Ui /O µ <br />Addree[y')�`-i \ n� ��(l Loto �0 ��ii Block �� �-�� <br />City(( ��f�0 � PhonE��� Subdivision (Plat) � IM ilvt ��7�. `tJ. �. / S� <br />� �,ve�.. <br />Arehitect/Engineer <br />City �- Phonc \ Metes & Bounds (Unplatted) <br />Contracto���nOlti'� c� r�.,(�(�QJ,,n Sec. Twp._Range <br />Addres�� , - <br />City��Z'h � � - I ! Bvilding Use <br />State License NumbeF9�OI-I�Y-u� 6� Describe Work ro be Done <br />Expiration Date � �Yl-1�___ I ""�— <br />SKETCH PLOT PLAN B�LOW <br />Uee of Building • � <br />.L7New [jAddition ��pair/Remodel <br />n on <br />Yaluation of Construction S`(�Q_ <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width ot alleys, <br />locate proposed and all existing � <br />buildings, show distances to prop- <br />erty linea, show distances between <br />buildings. <br />Lot size <br />Lot area Sq. F[. <br />Sizc of Bldg. Sq. Ft. <br />Number of stories <br />Basemen[ <br />�31gne Date <br />Fo\�t �\�-�1.�\�- <br />Owncr Phone <br />DO NOT WRIT� BELOW THIS LTNE - FOR CITY USE ONLY <br />Date Received 3` 5-75 Use Zone <br />Plan Gheck Number <br />Valuation��� � <br />Permit Fee ( �• � <br />Plan Gheck Fee <br />Total Fee Due <br />Date Issued <br />Fire Zone <br />Occupancy Group <br />Typc of Construc[ion _ <br />Occupant Load <br />Sprinklcrs Required _ <br />