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llUILDING PERMIT APPLICATION <br />Applicnnt To Complete This I'orm <br />/r ��,� <br />��/� y/� <br />If more than one building is to Uc constructed, submit a sepe.rate permi'� ap- <br />plication for ea.:h building. A separate permit will be issL=d for each build- <br />ing. , „ <br />owner�2s u i% L'+.:i `i�`iu� ����-.n� <br />Address �"7�' �'T /��^ _ .C'litit-L� <br />city �./'tiLl��"�nPFione�5�`�-310Z- <br />F�rchitect <br />City Fhone <br />Contractor /�!/r.�-c�-Cl�c��,�,�� ��M • - ,^J � <br />Address ( �'�� / l/<�-�+�X� d / % � <br />City �,C... Phone 4�5 ���7�4 3 <br />State License NumY�er �2� 3 Dl /�S ��� <br />/ ' <br />Eapiration Date� �/ � <br />U <br />Date�Iteceived ��/��'J� <br />Ylan Check t2iunbex� ��7�i -�-'.�L7 _ <br />Valu�l:ion •� �.i, �p=:��J <br />Pcrmit Fee %%<; � CUv <br />Plan Check Pee �'-]. S� _ .__ <br />Total Pee Due <br />Permit Number <br />Date Issued <br />IIuilding Address ���u� < %�{u-�� CC1��`'�i , <br />Lot ,.2 I IIlk. � Sec. <br />Twp. Rge._ <br />Subdivision (Pla�, �//l0-tL �LPi� <br />Metes & Bounds (Unplatted) <br />Building Use�!/ � �� �-(_�.c.c _ <br />Describe i4ork to De Done __ <br />Use of Duilding <br />,'_�dew .- Addition Repair/Remodel <br />Valuation of Construction $ Y�. l� <br />PLOT PLF�LI <br />Indicate lot si�e, name oL sfseets, <br />indicatc location and �•:idth of <br />alleys, locate proposed and al.l <br />existing buildings, show distances <br />to property line^„ shota distcmces <br />bet-weeu buildinqs. <br />Lot size x <br />Lot area S.r. <br />Size of II1�g. _ S•r• <br />Number of Stories <br />IIasement <br />Use 7,one <br />Signed By �� �7 ,%. ��.� Jd/�,��°� <br />?�l �-Cc(c ; C4-�c�:.-� . <br />r..,,- % <br />owner <br />TIiIS LING-POR CITY USG ON <br />Pire Zone �� _,_ <br />Type of Construction_ �7 -`� __ <br />Occupancy Group 1 <br />Occupant Load _ <br />Sprinklers Requirod __ � <br />APPROV.Ep FOR [3UILUIfJG FERMIT <br />o,te '—__� ��_i _=av_�'� � _ . <br />