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BUILDING PERMIT APPLICATLON <br />Applicant To Complete Thia Form <br />/ 9�5'� <br />�/s�s <br />If more than one building is to be constructed, submit a separate permit � <br />application for each building. A separate permit will be isaued for each <br />bvilding. � <br />Owner1� 1�����.'i\ (�-V�.CI_L�'��� Suilding Address ,���� 11�til4Cl_ ��'�CI, <br />Addresa3c�-��Olf�(�in 1<CI, Lot �I Block <br />G � rI r (� <br />City � }�hS��'�" Phone�l� —' ��Subdivision (Plat)�p � )„ �j`ic� lD �.1��'�� � • <br />Arehitect/Engineer � <br />City � Phone 1 <br />� 1 � /� � <br />Contracto �y�� �71_l,ll'C�Q.h � `� <br />Address,� � "l i �7m �' � <br />_� ,� ( Jr� �� <br />Cit - Ph ie � �_�L <br />Metcs & Bounds (Unplatted) <br />Sec. Twp. _Ranqe <br />Building <br />Stace License Number�'��j-���/_//y,JS" Describe �Vork to be Done <br />Expiration Date (�, ,���75� � C `� -�� :��7i l0 \11��__'l _ <br />SKETCH PI.�OT PLAN IIELOtV <br />Uae of Bvildic�_ <br />L7 New L7 Addi[ion �Repair/Remodel <br />Valuation of Gonstruction $ r����. C(' <br />PiOT PLAN REQUIREMENTS <br />Indicate lo[ size, name of streets, <br />indieatc location and width of alleys, <br />locate proposed and all e�isting � <br />buildings, show distances to prop- <br />erty !ines, show dis[ances between <br />buildings. <br />Lot eize s <br />Lot arca Sq. Ft. <br />Size of Bldg. Sq. Ft, <br />Number of stories _ <br />Basement <br />Signed Sy Date <br />For <br />Owner Phone <br />DO NOT \VRITE IIELOW THIS LINE - FOR CITY USL ONLY <br />Date Received "Jr � 1^ Use Zone <br />Plan CUeck Number Fire Zone <br />Valuation ���'��� C�C� <br />Pcrmit Fee �(D. � <br />Plan Check Fec <br />To[al Fee Due ��- � � <br />Date Issued <br />T <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklere Required <br />