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" <br />) <br />Applicant To <br />Complete -This :orm <br />If more than one building is to be <br />centructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. <br />Omer �' /; 1_hl4J rJ> = ' 1 <br />Building Address " • / /,len a ,� a /�a <br />1 <br />Address f./ ry_ I' i 1 <br />Lot t ii, Block b <br />City /,g4;n n., r r• Phone % i(_• - <br />-- Subdivision (Plat) <br />` <br />Architect/Engineer <br />•?- r-, % FX ' /iJ-A,., <br />_ !•'`.:.'j <br />city Phone <br />Metes f Bounds (Unplatted) <br />Contractor n ;1,•t; <br />y Sec. 'Stop. Rge <br />Address <br />Y. <br />city Phone <br />_ <br />Building Us_ li-.J✓�� <br />i <br />State, License Number > J 3 - C - '� �/ Describe work to Be Done <br />'I <br />Expiration Datt 1 - /- %G <br />0t :n�ic1-� tL <• <br />SRETCF: PLOT PI Ln BELOW' <br />r Uge of Building <br />14 �7? .. y <br />a• a -„• " dNew ❑ Addition ❑ Repair/Remo_el <br />�• •-Gj: �• Valuation of Construction 5- <br />a PLAT PLAN REQUIRE}IENTS <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 6 c' x !'). <br />. Lot area Sq. Ft. <br />Size of Bldg. • coo So. Ft. <br />Number of Stories <br />Basement -t— <br />a -- <br />Signed By i?.r„ <br />For <br />Owner Ph- e <br />n <br />. DO NOT 101TE BELOW THIS LIRE -FOR CITY USE OZ' r: <br />Date Received -2. 5 Uce•Zone <br />Plan Check `lumber 71-:) ` q-fiQ Fire Zone <br />Valuation Er Occupancy Group <br />Permit Fee JL Type of Construction <br />Plan Check Fee L Occupant Load <br />Total Fee Due ''�_ Sprinklers Required <br />Date Issued <br />0 <br />