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a 3 �, <br />If more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for earn building. <br />Ovoer Building Address <br />Address Lot_ Block <br />City Phone- Subdivision (Plat) <br />Architect/Engineer <br />:..I city <br />Contractor <br />Address <br />City <br />State License Number <br />Expiration Datb <br />lu <br />_Phone Metes i Bounds (Unplatted) <br />Sec. Twp. Rge <br />Phone <br />a <br />Building Use <br />Describe Work to Be Done <br />i <br />zz416 1 1 <br />BELOW <br />Use of Building <br />lbL01. <br />. j <br />py I 'fiaa <br />NJ kC <br />PLOT P <br />❑New ❑ Addition Z Repair/Remodel <br />Valuation of Construction <br />PLOT PLAN REQUIRE.`lENTS <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. <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number of Stories <br />Basement: <br />Signed By <br />For <br />FrflJ% owner Phone <br />s aei nl�' <br />DO NOT SiZiTC HEL077 '=HiS LI:]E-FOR CITY USE 08 L'I <br />Date Received 17---, ^ Uce Zone <br />Plan .Chcc;', NunherTTT'� V i ¢ C-) Fire Zone <br />Paluation �" Occupancy Group <br />��. C% Type of Construction <br />Permit Fee ti--- <br />Plan Check Fee Occupant Load <br />Total Fee Due Sprinklers Required <br />Date Issued ,- i 7L <br />A DR v7itii.: F_a� <br />Qc Rc11�t „R�h�rl7S, <br />