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:, I <br />• ': r'i <br />: i <br />:� � � <br />. 'i <br />;i <br />� <br />� <br />DOILDING PERMIT APPLICATION <br />Applicant To Complete This ?orm <br />. . S <br />",i <br />If moze than one building is to be contructed, submit a separate permit applica- <br />tion for each buildinq. /A� separate permn.f: tiii�l be issued foz each bu' dinq. <br />�e1 -=y^"� / /- " � Buildinq Address �� ,� /J � <br />]Iddress r'�.E—�—T-T.-�� � <br />Lot � I 3`�� _ slocx 3 2' S� <br />City Phone Subdivision (Plat) �� <br />IIrchitect/Enqineer ' � <br />City Phone Metes i Bounds (Unplatted) <br />Coniractor ��Lz� ,`, ����� � .. <br />y�1�� Sec. 1Wp, Rqe <br />1lddress �.-7 .3 3. i=��1, ��.. il/ ,�- , . <br />�tY�%�� Phone � 5�.. , � Buildinq Use [— � <br />' : f. •. �... <br />State License Number`�) �3 -o/ _�`X�, ;� pescribe Work to Be Done ' <br />bcpiration Dat� �.�L �7.5__ • ) -,' <br />�� <br />. -7- 7-� /(���:._-t,_, <br />. � SRETCH PLOT PLAN BELOT9' � • Y <br />Vcluaticn � ' Permil <br />Plon O —__Paid:. . . <br />=+—p...� .. � n,m. I ': r,���, <br />{i:;utln) I To �ppvd �. ._" <br />� �i �.:j� —!�—� <br />2 F�n� I,---- <br />3 � [�:zp I <br />__ �a-� <br />•.,Plon ChKk No. 7S l <br />i <br />SN � °(—�— <br />Date Seaeived <br />e <br />Ose of Suilding • <br />�New ❑ Addition Repair/RemoGel � <br />Valuation of Construction $ / �Q() � �—"— <br />1, PLOT PLAN REQUIREAtENTS _ - <br />% <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />eacisting buildings, show distances <br />to propert•f _ines, show distances <br />bettreen bu i.tdi ngs. � <br />— Lat size X <br />ILct area S Ft. <br />�Q_ Size of Blag. Sq� Ft. <br />� Number of Stories 4 <br />Basement <br />Signed By��,y,,,� �r,� , ,-Q�D <br />For !s=, �� ._ �j i�-- � 7CT <' "_ <br />, Owne � Phone '' <br />� <br />Plan C:Zec� �7ur,ber 7� /�,C'� <br />Valua:ion __f �� �C�rj-.db <br />Pemit Fee j�, - m C' <br />Plan Check Fee <br />Total Fee Due �. � ��-�_ <br />Date Issued - ,'Z <br />� LI:IE-sOR CITY <br />c <br />Ace 5one <br />Fire Zone <br />Occunancy Grou� <br />Type of Construction <br />Occupant Load <br />Sprinklers Require3 <br />n <br />