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--• -- - . ._ _ _ _. . -� � -- -_ ._._ ....._ <br /> BUILDING PERMZT APPLICATION � . �/`� — J�.��` <br /> Applicant To Complete This ^orm �9G .� <br /> 3�/s�76 <br /> If more than one F:uilding 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 TE/QL' y' S%!J/Ti'f Building Address <br /> Add::ess �,SZ Z ���(/f" Lot Block �� c�- <br /> � <br /> City � v£/C �T7" Phone Subdivision (Plat) �� o`n �N a(���'v`�� <br /> Architect/Engineer ' o� I b� `�J�. n.�. -lRc_ f�l h5��ti� ��o �� S �5 <br /> -l_ E �, O <br /> City Phone Metes s Bounds (Unplatted) <br /> Contractor �'�ETT .8�� � G Oc� S Sec.�__ 7tap.�_ Rge � . <br /> Address �'G�O�v EvE�'�'.J'c�'�'� a�/�Sl ' <br /> , <br /> City ,Q��'�Q�TT Phone 3}3-7/L./ Building Use <br /> jp� -PN <br /> State License Number113—�/-Eb-ER -Elj- Describe Work to Be Done ' <br /> Expiration Date p?—�- 7/ SS'L�ii��''�� — �-'p��� � <br /> SKETCH PLOT PLAN BELOiV _ <br /> � Ose of Building � <br /> • ❑New ❑ Addition � Repair/Remodel <br /> /� <br /> pp <br /> ' Valuation of Construction $ f��'Q. <br /> ' • • PLOT PLF^I REQUIREb1ENTS <br /> � . Indicate lot size, name of streets, <br /> indicate location aad �ridth of <br /> alleys, locate proposed and all <br /> existing buildings, .show distances <br /> a '! � to property lines. show distances <br /> between buildings. <br /> Lot size x <br /> ' Lot area Sq. Ft. <br /> . � Size of Hldg. Sq. Ft. � <br /> . Number of Stories f <br /> - - Basement i <br /> � - � <br /> � Si ned By � <br /> \ I <br /> r o�_ ��\,�C�.,,_, _� � <br /> Owner Phone <br /> � <br /> DO NOT {4RITE BELO[9 THIS LINE-L'OR CITY USE Ot7LY ' <br /> Date ^.eceised U_e .".one � <br /> Plan Chec% Vunber Fire 2onc � i <br /> Valuation ��. � Occuoancy Grouo ` <br /> �J f <br /> Yemit Fee �"_`� Type of Construction � <br /> . � <br /> Plan Check Fee Occupant Load . ` <br /> Total Fee Due Sorinklers Reauired I <br /> Datc Issuc:3 C�T�.i r�., c• -T ' <br /> APPROVGD �Oi; i:.;...,_:. _; '�',.:"�.�li i <br /> ,. ; _ _ I <br /> �'�'-' ---— , _ _ <br />