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:' '' .. I . � . � � 80ILDINC PERMIT APPLICATION I . . . � ' --' �,. (� '�,i'�� <br />j . Applicant To Complete This 'orm • ' � '`T�� <br />, - � •/ �/::�� <br />Sf inere than one buildinq is to be contructed, submit a separate <br />•� tion for each buildin s� <br />�7 7� 4. 11 separate permit will be i�sued for eachebuildinqlica- �3 - <br />• . , � Ovner � �I/ L ,C. � ' %%G(C��L- <br />a <br />. <br />_ .'-1 <br />, : �' <br />•� <br />� <br />,� <br />. ::, ' <br />: ►1 <br />: .I <br />.'�,. i .� <br />� _� � <br />',' • , � I� . <br />��i'V <br />`"' ' ' I <br />�► . <br />. <br />�' . <br />i <br />� ! �f/ <br />..� ---�. y Buildinq Address J j a� �lf�s (.�i` (' <br />aaar�59 ,� 3..2 ! r %.-� � c,i �T — <br />� � Lc3tS � �� � r� Hlock - %i� <br />�tY GVE���� Phone�,S_�S� g�ivision (Plat) f--f <br />Aschitect/Engineer fC�T �'�S� � <br />City Phone _ Met <br />Contractc: <br />Rddress <br />City Phone .? av�c�� <br />State. License Number c� 7�-c� /._ �=�/ <br />Lzpiration Date <br />� <br />. <br />f 1,� <br />w <br />vw <br />- -C� ��.. <br />TL' <br />� <br />- Date Seceived '��/e ��', <br />Plan. Cyec� ;lur,yer <br />Valuation / SQQ . � <br />Pemit Fee / ��. ' �� <br />' 'Plan Check Fee � <br />: Total Fee Du <br />Date Issued <br />e /7� �u0 <br />/�/�i <br />es s IIounds (Unplatted� <br />Sec. � RgL . .. <br />Huilding Use , �. <br />.. :� .,.,, <br />Describe Work to Be Done ,`���' G� �� <br />� � � �— . <br />.:.(�,� � � . <br />- C� Q� <br />° � �t--rL.. , - <br />IIae of Huilding . <br />�New ❑ Addition �Repair/Remociel , <br />Valuation of Constzuction $� Q; �� <br />. . PLOT PLAN REQU2!2Eb1E.ITS <br />Indicate lot size, name of streets, <br />indicate location ann wi�th of <br />alleys, locate pr000sed and all <br />Facisting buildings, shocv distances <br />to property lines, show distznces <br />bAtween buildings, <br />Lot size X ' <br />Lot area Sq. Ft. <br />Size of Bldg. —_ SQ. Ft. <br />tivmber of Stories <br />Basement• <br />Signed By z , � � , <br />n ' G <br />For n i _ ,7%Gf : <br />�� <br />Owner Phone �_�� -�T,,� <br />� <br />! <br />Uce Zone <br />Fire 2onc <br />Occunancy Grou� <br />Type of Construction <br />Occupant L�ad <br />Sprinklcrs Required <br />� <br />., <br />