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BUILDING PERMIT APPLICATION <br />Applicant To Complete <br />This Form <br />If more than one building is to be contructed, <br />submit a separate 7��5/'� <br />permit a - <br />tion for each building.P <br />A separate permit <br />will be issued for each building. <br />building. <br />Owner _/7 pn / ✓ C (�` h <br />Building Address <br />Address /( f <br />Lot 3 O 7 3 ,� Block ' $" <br />City Phone <br />Subdivision (Plat) Z-ee S ,� N�-fr <br />Architect/Engineer <br />City Phone <br />Metes i Bounds (Unplatted) <br />Contractor CGs��c:QiYiYJSee. <br />Twp• Rge <br />Address <br />!, <br />City / f!,� .,.��jf Phone <br />Building Use <br />jState <br />License Number Z - <br />Describe Work to Be Done ' <br />i <br />Expiration Datb /% <br />CDGJS7Y�r C'T Fl<1 CY <br />+� <br />SKETCH PLOT PLAN BELOW* <br />- <br />/ <br />Use f Building <br />.- <br />dNew ❑ Addition ❑ Repair/Remo::el <br />Valuation of Construction $ -)-,Z O '— <br />k <br />"' <br />GG.aih L`h Jr-4 eHe r <br />_ PLOT PLAN REQUIRE-%ENTS <br />Indicate lot size, name of streets, <br />- <br />_ - <br />indicate location and width of <br />' <br />alleys, locate proposed and all <br />• <br />existing buildings, show distances <br />t <br />--,�-EOG[SC <br />to property lines, show distances <br />4 <br />between buildings. <br />fC I { <br />p (Z Kf ' <br />DO NOT WRITE BELOW THI <br />Date received 7//5 / -7 (� <br />Plan Check Number <br />Valuation E) <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Date Issued /,{ r <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number of Stories <br />Basement <br />Signed By.�n <br />For <br />Owner Phone <br />R CITY <br />U,-e Zone <br />Fire Zone <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />