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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more than one building is to be constructed, submit a separate permit ap- <br />plication for each building. A separate permit will be issued for each build- <br />ing. ) <br />1 AleA <br />Ownr- /' G� Building Address_.4 6S U),AA,n� <br />Address IFO S/, GLyn/.(/I. Lot3_� Blk• 4Sec. <br />City�),,.i ( YX04-4 Phone S.� 2 �(� Twp. Rge. <br />Architect <br />City Phone <br />Contractor <br />Address <br />City Phone <br />State License Number <br />Expiration Date <br />Date -Received .6411-71 -. <br />Plan Check Numb <br />Valuation <br />Permit Fce <br />Plan Check Fee <br />Total Fee Due S. _ <br />Permit Number « S� <br />Date Issued ///�Q/71 <br />Subdivision (Plat) <br />Metes & Bounds (Unplatted) <br />�17A 3 <br />Building Use / <br />Describe Work to Be Done �o C't n/ <br />Use of--Bui.lding <br />-.New . Addition Repair/Remodel <br />Valuation of Construction $��• <br />PLOT PLAN <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 x <br />Lot area S.F. <br />. Size of Bldg. S.F. <br />Number of Stories <br />Basement <br />Use Zone <br />'Signed By kl r k)11 11. _ -j! <br />For <br />Owner <br />USE ONLY <br />Fire Zone__ _ <br />Type of Construction <br />Occupancy Group <br />Occupant <br />Sprinklers Required <br />APPROVED FOR BUILDING PERMIT <br />BY -- <br />