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� <br />BUILDING PERMIT APPLIGATION <br />Applicant To Complete This Form <br />i%'Jy�` <br />�j�7��' <br />application for each bu d ngt� A separat cper�mit will be9i sued foreeach <br />building. o o �/n /�J ' _ (�,.���.J� <br />� ,� Bvilding Address c7f %"t �QS�� <br />Owner o 13 � lµ <br />� , ,�,c.o���B�o�k 3 <br />Addresa o � <br />City��Phon <br />�g��Subdivision(Plat) 0- <br />Architect/Engineer <br />�Phone�_ Metes & Bounds (Unplatted)�_ <br />City /'� <br />.�.,, ._ N-Q- �f'ti �, �/�OhP Sec. Twp.__Range�— <br />� -Q-Q' Pho��- ,(.�� Building Use <br />City�nn L�_ ,, �,� ����.� <br />State License Number�j�;��j��1L�escrihe Work to be Done�_- <br />�� i _ �//� �.� � 0-, an' k �n' — <br />Expiration Date_t�- - — <br />SKETCH PLOT PLAN BLLO�Y <br />Use of Building <br />.�New ❑Addi[ion�Repair/Remo�C) <br />Valuation of Gonstruction $ � � <br />PLOT PLAN R.EQUIREMENTS <br />Indicate lot size, name of stree[s, <br />indicate location and width of alleys, <br />locate proposed and all e�isting <br />buildings, show distances to prop- <br />erty lines, show dis[ances he[wcen <br />buildings. <br />Lot eize <br />Lot area Sq. Ft. <br />Sq. Ft. <br />Size of Bldg.�� <br />Number o[ stories <br />Basemenc <br />.. --�- ' _ ° '� �Da[e <br />Signed By <br />For. ��` . ' ����� _��_ ��_���/�� � <br />Owner P one��'�., <br />., .-rmv i�SF. ONLY <br />DO NOT NRITE BELu�+' ini� "'^" ----- - <br />Uec Zone <br />Date Reccived�._� . <br />� Firc T.one <br />Plan Check Numbcr��_- <br />c� OO Occupancy Group <br />Valuation �C{ �� ' <br />Permit Fee <br />plan Check Fee <br />Total Fce Due <br />Datc Iesucd <br />'pypc o[ Construction <br />Occupant Loan <br />Sprinklers Required <br />