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� BUILDING PERMIT APPLICAT:ON / �� �/ <br /> � Applicant To Gomple[e This Form <br /> If more than one building is to be constructed, submit a aeparate permit ����5 <br /> application for each building, A separate permit will be issued for each <br /> building. , <br /> i / <br /> Owner�/"/ / �y �yia��/-��'�/�/� Building Address �,1.:2 (-. -- ��Q ��c�< <br /> � 1 y'i �`� -i- . <br /> Addreas �,2;�� 1��/-� 1ti r S Lot/})J .�z� Block�(�,!j <br /> City l;�;I� {� �=�� Phone.2;�,�-G'-I�Si�Subdivision (Plat) �- �r /��_� , <br /> Architect/Engineer —� �/-l.id l7 (' o , �oT /-) J U <br /> City �" Phone "-- Metes & Bounds (Unplatted) <br /> Contractor_�i;.���r'�', r- /�C iJR 1.!_ Sec. Twp,_Range <br /> , Addrees����. /3ct iJU <br /> . City� ✓n rt %T Phnne�.�7:��/ 9/( Building Use ';�„ 5����iJr" �. <br /> State License Numbe�,2,j—(I/ -([��J� Deacribe Work to be Done ��7�� f�� �i/ <br /> Expiration Dste ,�'c An r c�{. � .,- (7(IZ�� n-u .I V �a�n <br /> SKETGH PLOT PLAN BLLO�V <br /> Use o[ IIuilding <br /> j�N y. � New ❑ Addition .[�epair/Remodel <br /> ' � yni � <br /> �lo ���i f�.9 . <br /> Valuation of Construction 5 ��li�� '' <br /> i PLOT PLAN REQUIRF.MENTS � <br /> Indicate lot size, name of streets, <br /> , indicatc location and width of alleys, <br /> '� locate proposed and all existing <br /> ' ___..__._.. _ . bvildings, show distances to prop- <br /> � ��� erty lines, show distances between <br /> � i � ,�=� bvildings. <br /> � �—. :--•—_—_ _ . <br /> � � '� Lot size x <br /> i i i <br /> i ' a ,u — ��' Lot area Sq. Ft. . <br /> qT , <br /> I � �� Size of IIldg. Sq. Ft, <br /> � <br /> ------��� Number o[ stories <br /> Basement <br /> . �—S,.n_c.ri� - , <br /> ' I� I - I I Signed By Date <br /> . ---�- ---------� --�--- --'--- '. For <br /> Owncr Phone <br /> DO NOT 1VRITE BELOW TfIIS LINE - FOR CITY USF ONLY <br /> � Date Received 2 -f3-� �� Use Zonc <br /> Plan Check Number Fire Zone <br /> Valuation �-}--l�l� � ��J'z'�� Occupancy Group <br /> . Perm'4 Fee �•�- �9�� Typc oE Construction <br /> Plan Check Fee Occvpant Load <br /> Total Fee Due L�'�� Sprinklcrs Required <br /> Date Issued � —��'7� � <br />