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. SUiLDING PERMIT APPLICATION //�,/�� /' � <br /> � . � � Applieant To Complete Thi.a Form ' 7 (/ <br /> �K <br /> � � . If mor.e than one building ie to be conekruetr.d, �ubmit a eeparate permit j� f/�s <br /> ' . appli�.:ation tor each building. A separate permit will be iseued for each <br /> building. <br /> Oaaer �C.�P.�.� \�) �E�) BnildingAddreee � �3�0 ���A�JGv� KA . <br /> Address � �j�O l�'�"�u:�.,..�f��''Lat � � Blaek � <br /> Cit7��1Qv'ct_�l Phone353-R'�S .ubdivisioa (Plat) Pj�o2���7cv{ �aS\ <br /> Arehitect/Eagineer��E(LA�-�� �F , �GE� Q.�. <br /> City �.V Cr��v,� Phone . 3-'I9�S Metee & Bouade (Unplatted) . � . <br /> M -vC-�=.�c LS't-94 �, � . <br /> Coctractor__\,\�. � ¢`� � See. � Twp._Range <br /> Addrea6 --' <br /> City Phone -- Building Uae `� O�[Yl Q. <br /> . State,Liceaee Number ` Deecribe Work to be Done ��¢� �n�ro,o✓r�S/ <br /> . E:piraHon Date � �=ti.pa.r.�e� k�'Rt��c., � llc������a <br /> SKETCH PLOT PLAN BLLOW �j �c ¢_. �tn v-2tir o`� ¢-Y-��l�iV:q 4�o�'nc-' <br /> � '�� "U�e of Building �p�Q <br /> � - ' � Q New �Addition j�Repair/Remodel <br /> Ex\�.�1rlCz ' 4� r <br /> � G�Rn�C Valuation of ConstrucHon $ �0��� � <br /> I I � � � � PLAT PLAN REQUIREMENTS <br /> � i � i <br /> � � � � b I . <br /> � I � i i i , � � ' Indieate lot aize, name of st:eets, � <br /> � � - '-�-' - �� ,-' �____�-�'_ _ � indicate loeation and width of alleys, <br /> � O � . � , locate proposed and all existing <br /> 1"1 I AODi c�oc� � buildinga, ehow distances to prop- <br /> _ t - � � arty lines, show distancea between <br /> `,p �� - buildinga. <br /> c� ,���.;t�-�,r.a - � i <br /> Lo! �ize Qi� z ��� <br /> � ' Nous�� • . ` ' <br /> _ � = Lot area ` �F�o�n Sq. Ft. <br /> �, Size of Bldg. , ��� Sq. Ft. <br /> :; T, � -� <br /> � •� Nnmber o[ stories <br /> I C����� U . � Baeement �C� <br /> 1 <br /> ' Q � � . ' 1 �a Signed By Date <br /> � � 0 <br /> • I ` l G31 O . For <br /> WF'�CL��L'�-V �"�O �MEK�C�f1l�\� �Oa'aer Phone3S3-9 oS <br /> l��oY`� zS�\- 948t3 <br /> DO NOT WRITE SELOW THIS LINE - FOR CITY USE ONLY <br /> Date R^_eeived S -�7' �.� Uee Zoae '�L� S , <br /> Pun Check Number� � ^� �t � Fire Zone 3 <br /> , Valuation I Z ��, J�.7 Occupancy Group. Z <br /> Permit Fee � l,•0. ��-u T of C nstruction � - h-� <br /> Plan Check Fee � 3 J. J"J cu ant ad <br /> Total Fee Due S J.�'� ri re q - <br /> Date.I�eued ' � � • � <br />