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: Jti plieant To CompleteThis:orm y <br />if =ore than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will bu issued for each building. <br />Omer 1; ,tj_j Building Address z y,, I 1 +rf ern Gnr: <br />, <br />t Address f tO 7�• "z _ /'i 7 Lot S 4 / L• Block S 3 <br />City 4 Phone '%'9�-/i�� SubdiVision (Plat) <br />' Architect/Engineer �,.u_ t+��* _ ¢ E,.t <br />t� �. e ,.c ..Z (_fin - l ,mot Col tLw• <br />77- <br />_ .'.✓j. .._'i city �v' �'- Phone Metes 6 Bounds ;Unplatted) <br />Con`.ractor F.Js .urn a�vt/i�orc¢7, Sec. Twp. Rge <br />City d n2cv ez Phone / / /, -%f `1 Building Usew�%p-r- <br />State License Number 2 27- 0/- ,'�4�/ Describe Work to Be Done -( <br />•1 Z*iraticn Batt .'//o �i�,r,-•� r• ^Y.�t�`•r�_(iG-Ce�>-„t - <br />SRETCH PLOT PLAN BELOT-V <br />Use of Building <br />l• y • • t. _ •.New ❑ Addition ❑ Repair/Remo::el <br />t• j' Valuation of Construction $ <br />�, �. '., .:;.�•• -;t;" �9 •n�: PLOT PLAN REQUIRE.=NTS ; <br />2Zidicate lot size, name of streets, <br />-indicate location and width of <br />�. alleys, locate proposed and all <br />, existing buildings, show distances <br />1 ? • "�"" r �� ~�i to property lines, slow distances <br />.: •- ----.. y . , netween buildings. <br />• .' '' • - ..� •, Lot size x / r< <br />. - ! . Lot area <br />7 q C 0 Sq. Ft. <br />�• .` �, Size of Bldu. So. Ft. <br />�i Number of Stories / <br />( Basement <br />•' Signed By /p�/, <br />For <br />Owner Phone <br />DO NOT 10ITS BTLOW THIS LINE.-FGR CITY USE ONLY <br />Date Raceived /;/71� Ute- Zone <br />?jai, Caeck. Number 7S 412 Fire Zone <br />w <br />Valuation occupancy croup I <br />Pewit Fee O Type of Construction ^V l <br />Plan Check Fee 4' 9. 'C'O • Occupant Load <br />Total Fee Due <br />Date Issued <br />s <br />Sprinklers Required <br />CITY,. 0 FV�( EtT <br />APPROVEEF.iFn B1JJLO11VG.%ERMIT <br />Y. <br />• --r <br />