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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 a <br />' e <br />7 ner a <br />� <br />1 Cit `ra/ %rf—Phone <br />i Architect <br />City Phone <br />Qdlz <br />Contractor v <br />Address /, 9XIU <br />Ci tv�' i•/v/J %/ %—Phone <br />State Liconse Number <br />Expiration <br />/I <br />Building Address e <br />Lot- Blk. Sec, <br />Twp•_ Rge. <br />Subdivision (Plat) 1 ...t�l!-I I mo" x <br />Metes 6 Bounds (Unplatted) <br />Building Usea <br />Describe Work to Be Done <br />' �c!N( e- (rcN(2 &,�G ' A4- <br />Use of: Buildi <br />-New Addition `1�epair/Remodel <br />Oct <br />Valuation of Construction <br />$2>• <br />PLOT PLAN <br />Indicate lot size, name of streets, <br />indicate location and %:idth 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 <br />S.F. <br />Size of Bldg. <br />—S.F. <br />Number of Stories <br />_ <br />Dasemont <br />Use Zone <br />-_ Signed B , <br />i <br />For <br />Owner <br />WRITE BELOW THIS 11INL-FOR CITY USE. ONLY <br />Date -Received 11114/%) <br />Plan Check Numbe� <br />Valudti.en 2 �� �I• eS - <br />C— CMG <br />Permit roe <br />Plan Check. Fee <br />Total IPee Due <br />Permit Number. <br />Date Issued <br />Fire Zone <br />Type of Constru <br />Occupancy Group <br />Occupant Load <br />Sprinklers Required <br />APPROVED FOR BUILDING PERMIT <br />Wte.�By _ <br />i <br />