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N <br />HUILDING PERMIT APP7.ICATION <br />Applicant To Complete This Form <br />/�j;�� <br />3�/�J <br />If more tl�an one Uuildin9 is to be constructed, submit a separate permit ap- <br />plication for each building. A separaL•e pesmit will be issued for each build- <br />ing. <br />/ �/j <br />\ owner C�B�F[ l kt SSE��'� <br />Address_ �tl-�Q- �°Cl�� �����✓�. <br />City���� Phone � - D �.. <br />Architect ' <br />City Phone <br />Contractor __ <br />Address <br />City <br />State License NumUer' <br />�xpiration Date <br />Phone <br />��N p-v <br />rr�l_ rii. <br />��-+---� - -- � <br />iN,{ . � <br />I_� �..�..�_.._._-. _ .. . . -I� <br />_ - �I1 <br />.... _�'�'_ .. <br />'----- � :) �. <br />sl���;.,r.�- <br />►'u�.. k„ � �'' <br />. i�0 tdOT [4RITE IIELOl4 <br />Date Received ��pT_� <br />Plan Check Numbcr � <br />Valuation �� ��— <br />Pe_mit Pee lj . C3-Z..i <br />Plan Check Pec _ <br />Total 1�'ce lluc_� V`Z� <br />Permit Numbcr /�'l �j�% "� <br />�at� Issuoa� .��7 C � <br />Duilding nddress � 3Q�%,/- %'�k k� � �/�!/� <br />Lot! � Dlk._� Sec. �H�sc6 �(/-P/'x� <br />Twp. Rge. <br />SuUdivision (PlaL-) <br />Metes & ➢ounds (Unplatted) <br />Building Use Gi.a'zt-7� <br />Describe t�7ork to IIe Done <br />G � �,,. ��✓�'- walk a.,J /^-�a'zE�o <br />v <br />of IIui <br />'- New - Addition . Repai.�rt�/Renodel <br />t'aluation of ConstrucCi,on $ T,Ij� •OD <br />PLOT PLNI <br />Indicate lot size, name of streets, <br />indicatc locatiwi and �aidth of <br />allcys, locate proposed and all <br />existing buildin9s, show distances <br />to proper.ty lines, show distances <br />bettuecn buildings. <br />Lot size x <br />Lot area S.P. ; <br />Size of llldg. S.r. I <br />NumUcr of Slories ' <br />IIasement <br />us� zw,� <br />Signed IIy <br />�� For_�j, .�. f�.�. ���--L_E!i <br />Owiie <br />13IS LINE-FOR CITY USE ONLY <br />Pirc Zone <br />Typc of ConstrucL•io: <br />Occupancy Group_ <br />Occupant Load <br />Sprinklcrs Required <br />�� � �! 7� �� � <br />PPROVED FOR QUILDING P[RMIT <br />oatn _ <br />� <br />a <br />