Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> � Applicant To Complete This Form <br /> , If more than one building is to be constructed, submit a separate permit � <br /> application for each building. A separate permit will be issued for each /�9(�� <br /> building. "� C <br /> � �/ 70 <br /> �Owner�/ /����,��j/_/���//y�- Building Address .Z � �: 3 � � / � �� � <br /> Addrees p, �L/CT���'�� Lot S�.G.j Block ,r6 � •/� � C�,..,�1 � <br /> .. � a , <br /> CityS4��'���j PhoneSl�-���6 Subdivision (Plat)__�,�;,/ � �„?,,,..L� <br /> Architect/Engineer /L/ .� n /.J,f/���i��/�/n/�_ . <br /> City PhoneS Metes & Bounds (Unplatted) � <br /> � Contractor.�/� iLJ� Sec. Twp,__Range <br /> . Addrees ��GJ ����� ��.,�� �� G�-/` <br /> , City -Si'3C/ l� / <br /> � �lM� C Ll Phune S_l� /�Building Use �(�'�,� 1'i �P2 C'c' - t ir-lC. �-E F-,\(� 1\`% <br /> State License Number ��3�0�-�/ -3� Describe Work to be Done � " <br /> y Ccnic�i � c7T- N` � <br /> Expiration Date <br /> SKETCH PLOT PLAN B�LON <br /> Use of Builair� <br /> , � .�l'New L]Addition ❑Repair/Remodel . <br /> Valuation of Construction S �,y-� C'G 6 <br /> PLOT PLAN REQUIREMENTS � <br /> Indicate lot size, name of streets, <br /> indiea[c location and width of alleys, <br /> locate proposed and all e�isting <br /> buildings, show dis[ances [o prop- <br /> erty lines, show distances betwren <br /> _ � . buildings, <br /> � Lo[ size . S('� x ��� <br /> Lot area ��a d Sq. Ft. <br /> Size of Bldg. 2.� X �/O Sq. Ft. � <br /> Number oC stories / <br /> Basement i' <br /> Signed By�J�Y//,�,r �i�y/��^ Date -Z' z.5 /�� � <br /> - - � For <br /> Ownc: Phonc , {` . - 73 l� <br /> DO NOT WAITE BELON THIS LINE - FOR CLTY USL ONLY <br /> � Date Received � - ��-��J Use Zone � _Z <br /> Plan Check Number �j - � 3¢- Fire Zonc Z <br /> Valua[ion_�,k `�-0 pccupancy Group -j <br /> Permit Fce � p r, �..r. Type of Construction��V <br /> Flan Check Fee j �,,}-� Occupant Load <br /> _ - ERETT <br /> Total Fce Due � �, Z , _ � Sprinklers Required q o�?n�iFf1 F(1R RI II <br /> P LDIN�T <br /> � Date Issucd � / <br /> D'�'' �-�2-�-/��'-- t3Y �t,.'` <br />