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BUILDING PERMIT APPLICATION � CJ � �7 . <br /> , Applicant To Complete This Form / 'T / <br /> � ' If more than one building is to be constructed, submit a separate permit _i/S�K; <br /> • application for each building. A separate permit will be iasued for each <br /> • buildin . ;� /'�,., /� <br /> Owner� �AC� ��L�'���1!71n- � Building Address���� / ,CC IOQ.�/ , <br /> Addrees�7S�N� ,Q� `��-h � _ Lot�„_Block�i�� ,3�0[� U-o0 <br /> Phona-"� � �� Subdivision (Plat) + .�U:J," 1-�' lk��! � ��, <br /> r <br /> City� l l-( 1� c�'��--. � <br /> Architect/Engineer \ � <br /> City � Phone�_ Metes & Bounds (Unplatted) . <br /> T— <br /> Contract��p �,c-tt_�.-��� .' , i ;�Sec. Twp._Range <br /> � ��� � <br /> AddresaY . � � � � � <br /> r. <br /> City 1� 0 Phon - ��� Building Use . \ <br /> ' ���j_�p Describe Work to be Done ��� �d�11�J <br /> State Licenee Numbe <br /> \ � `1 i <br /> . ExpirationDate l.,-�-�I� � nm� ``� 4c '��� � � <br /> SKETCH PLOT PLAN SELO�'V � <br /> Uae ot Building. —. <br /> .Q New [] Addition epair/Remodel <br /> �.n CO <br /> Valuation of Construction S �'�In . --- <br /> PLOT PLAN REQUIREMENTS � <br /> � Indicate lot size, name of streets, <br /> indieate location and �vidth of alleys, <br /> � locate proposed and all eaisting <br /> � � buildings, show distances to prop- <br /> � . � erty lines, show distances be[ween <br /> buildings. � <br /> Lot size X <br /> ' • Lot area Sq. Ft. <br /> -- Size of Bldg. Sq. Ft. <br /> Number of storiea <br /> Basement <br /> igned By Date <br /> Fo�_� , :� <br /> � Owner Phone <br /> DO NOT WRITE BELO\V THIS LINE - FOR CITY USE ONLY <br /> . Date Received -�'�_�3�75/ Usc Zone <br /> Plan Gheck Number Fire Zonc <br /> / ���f) ���� Occupancy Group <br /> Valuation_r �� . <br /> Permit Fce V� � � 'Iype of Construction <br /> � Plan Check Fee Occupant Load <br /> Total Fee Duc Sprinklers Required <br /> Datc Iesued � <br />