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-=- ' -- - - . _. ._ _. . . . _ --- - - -- - -- - �- -- - . ..a` <br /> BUILDING PERMIT APPLICATION /�� �- ��f <br /> Applicant To Complete This ?orm ��/���_ <br /> If sore than one building is to be contructed, submit a separate permit applica- <br /> tion for each building. A separate permit will be issued for each building. ' <br /> • Owner �L���L/7tip �fJf�/+P,ns.-T �� � Building Address �/�C' /��1Z//=� c . <br /> --7 �� <br /> Address (J�• r s'f� Lot .J/ �7-. Block 7/f� <br /> City �de�: // Phone ��-y/i/ Subdivision (Plat) �✓f,.r /fJ Lnnn/ �' <br /> Architect/Engineer /GJ�/�� `Af -�N� /�<AG / �r ��f.��� �i°.� , <br /> City ��z;� rJ1" Phone �3-}=Z6ou Metes s Bounds (Unplatted) <br /> Contractor ,v�.F.c�-�n «�7t• C�' Sec. Twp. Rge <br /> Address �� X 1�� . <br /> City =! G1f�_ Phone �. � � <br /> �J%-f�/j'/ Suilding Use / n7/=�: 6✓ �s'fie .iJ[ <br /> State License Number �� �� � / - 7'.�"C.t Describe Work to Be Done ' <br /> Expiration Date N/_-�l fG ✓�t {��£ � �NQ• /��06'• MT� � <br /> AETCH PLOT PLAN BELOIP /"'�'��-h�� $ fI-��? t�� C�;��CG <br /> Use of Huilding �Mr-c �4,iJx,�x�1L � <br /> • �New ❑ Addition ❑ Repair/Remodel <br /> � / Valuation of Construction $ � ��� <br /> �— �• �G Q o ���-L ' . . PIAT PLAN REQUIREhffiNTS <br /> Indicate lot size, name of streets, <br /> � / indicate location and width of <br /> /j � alleys, locate pronosed and all <br /> � � � existing buildings, si�ow distances <br /> � • �y � to property Lines, show distances <br /> � between buildings. <br /> �. <br /> � �� r Lot size .S'.5x /1 U <br /> V � <br /> �� Lot area (' ]'J-2 Sa. Ft. � <br /> �' Size of Bldg. J r ri�o � Sq. Ft. ; <br /> �, `—Flumber of Sto�ies � i <br /> • �' ' Basement u c <br /> . Signed By 11 /K �!y � <br /> For .fJE�'/+3,J �. c' �. <br /> Owner Phone 5q 9i y / . <br /> � DO NOT WRITE BELOW THIS LINE-POR CITY USE 0:7LY I <br /> Date 7.eceiced CQ 7�_ t7_e Zone C�z� ��U� �MG -LT. MF-'(ry � <br /> Plan ChecY. 9unber 75 -7i70 Fire 2one �7i � _ ' <br /> Valuation � � �. • �'�� Occuoancy Group I <br /> 1 <br /> Pemit Fee <br /> ��f'�O ' �-� � Type of Construction <br /> O t <br /> Plan Checl: Fee �� � L� Occupant Load , � <br /> Total Fee Due �i� .3 •Q d Sprinklers Required ! <br /> i <br /> Da:c Issucd . - . <br />