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' BUILOING FER6fIT APPLZCATION <br />, �; Applicant To Complete Thi� r•orm / 9 Q 3% <br />: � ,/ <br />If mure than one buzlding is to bc con�tructed, submit a ceparatc permit �e- �/3/J/ <br />plication for each building. A separaCe permit will be issued for each build- <br />ing. <br />Owner � tC.-a ���� i7 ' W t`A� �-� `/` <br />Address%G� �. C:�Ly'N, P�C f3C..�� D <br />hl�-S2�- 73: J. <br />City �V Ei'� T i- Yhone� �-�•i- 4-, ���� <br />Architect <br />City <br />Phone <br />Contractor <br />Addresc <br />City Phone <br />State Licensc Nun�ber' � � <br />E>:pication Date <br />i - - - - - �,k= - ------ <br />54 � Ir <br />\ <br />�� <br />8 �- <br />i' <br />�t, � i <br />— --- --� <br />Qz N� <br />---- — ---- - —1 <br />Duilding AddYess�tYl(., C`t_�%�Ut='�C l?l�'�� . <br />Lot�2 olk. Sec.VIL'W 2i Olif ��_ <br />Twp. Rge. ' <br />Subdivi:;ion (Plat) _ <br />Afetes & }3ounds (lnpl.atted) _ <br />L'uilding Use <br />Describe f4or3: to IIc Done QDL7 1 Tl b�i <br />C�a. TW C C'= )!3�"7�Loc' I-A � <br />Use of IIui. <br />- New �Addition Repair./Renodel <br />\'aluation oL Constructi,on $ � _ <br />PLOT PLAN <br />Indicate lot size, namc of streets, <br />indicatc location and i;idth of <br />alleys, locate proposed and a11 <br />exicting buil.dings, �how distances <br />� Lo property lines, show distances <br />bettaecn buildings. <br />Lot- size �^ x /Gt� <br />Lot area � S.I��. �, <br />Sizc oP Bldg. S.P. 'i <br />Number of Stories <br />llasement <br />Use Zon <br />Signed 13y , �(�,y'+ <br />��a� U � <br />Ou�ner <br />DO NOT 1JR77'G 131iLOP7 TIIZS LINI. POR CITY US1'. ONLY <br />Cate i�eccived $� Ly-��'� Fire 7,one j <br />Ylan Chcck :lumb�: � 'lj - 1�10 Typc of: Construction '�'- til <br />'Jalu�tion k J�-`-�� �� L _ Occupancy Group j <br />Permit I'cc 9-�l-.J�ti Occupant Load - <br />Plan Check Fce__ 'z.2. J�O Sprinklers Itequired � <br />'rot:�l 1'ec uuc �,�, . .?-�? _._ CIT'f O� � VEREI T <br />Permit Numl�er - _ <br />1)ate Issucd <br />/ � � � <br />� 1r <br />i i .'� _t-.�/ ��� _ J <br />, ; c—._ 3-Z4_ <br />Af�PRO''�_i) �� ; �'.•.�JLDING .PER��III <br />/ <br />Date . _.: ` � � _� �-. .� Y�� � �� <br />APPf?OVED COR DUILDING PERAIIT <br />n.,�„ <br />