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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more than one buildingis to be contructed, submit a separate permit applica- <br />tion/fJ <br />for each building. P � 4• A separate hermit will be issued for each building. <br />'\LILZ(�Q �)�YY1 Cl trl) Building Address <br />Address L-� � Y Q 4,ALot 9L ) Block � 0 <br />City P ' ^, Phone <br />— / Su vision (Plat)( <br />Architect/Engineer <br />City _� Phone ��\ Metes 6 Bounds (Unplatted) <br />Contractor r vGZ.e_ h.n Sec. <br />Address <br />Twp. Rge <br />� (�QnP]1��Mr� ) � <br />City l l nC(ry7� phone ' 1�--�71i Building Use <br />State License Number,=21_0/_ 11-1,2cP Describe Work to Be Done <br />Expiration Date G, .v _�m <br />SRETC11 PLOT PLAN BELOW <br />- <br />Use of Building <br />C]New ❑ Addition 'Q'hepair/Remodel <br />Valuation of Construction .011 <br />- <br />PLOT PLAN REQUIREMENTS ' <br />Indicate lot size, name of streets, <br />_ <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings,.show distances <br />to property lines, show distances <br />-, <br />between buildings. <br />• <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Hldg. <br />Sq. Ft. <br />Number of Stories <br />" <br />Basement <br />Signed By <br />{ <br />For <br />iP <br />Owner Phone <br />DO NOT WRITE BELOW THIS LINE -FOR CITY USE ONLY <br />Date 7aceived <br />Use Zone <br />Plan Check Number <br />Valuation <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Date Issued <br />Fire Zone <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />CITY OF <br />APPROVED FOR LiILD;'NG <br />Date Qy <br />I <br />