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HUILDING PERMIT APPLICATION /(� /� ••j <br />Applicant To Complete This ^orm <br />�/,� <br />If more than one building is to be contructed, submit a separate permit applica- �s <br />tion for each 6uilding. A separate permit will be issued for each building. <br />Owner �/Zl�h/L` %�'J1 �`"�`� Building Address /S� �i4N� FJLpQ <br />Aaazes5 �d r� i�/ rr 'r. �r v� Lot 3 a Bio�x <br />City Phone Sub3ivision (Plat) ��{ �1�b�. !J/1 TF/Z <br />Architect/Engineer `'L � �T� 4S3L-000-�3g-ao✓j <br />City Phone Metes s Bounds (Unplatted) <br />Contractor !v �IUL<�til/) C OPJ S r Sec. '�p- R4e <br />Address !�. a ,jG�( �j'{� � <br />City t CI �![ F// Phone ZS y`�7��/ I Building Use � <br />State License Number 22 3' o I'�i y0 Z Describe Wurk to Be Done �r I�l� ��1 ' <br />Expiration Date o5-2;-�� /%/-±GL/N6� ��/ Cfi�_ <br />SRETCH PLOT P7�1N BELOW A C C//Ji�(T - <br />Ose of Building CON,( u-r��.tc IA L o����� <br />. ❑New ❑ Addition �Repair/Remodel <br />N / <br />� ' Valuation of Construction S 9 6 a <br />R � <br />• PLOT PLAN REQUIREFIENTS <br />Indicate ].ot size, name of streets, <br />indicate location and cuidth of <br />a.11eys, locate proposed and all <br />existing huildings,.show distances <br />to proper'.y lines, show distances <br />between �uildings. <br />Lot size X <br />Lot area Sq. Ft. <br />� Size of Bldg. Sq. Pt. <br />Number of Stories <br />Baseme : <br />Signed By � c.4Y�P J � <br />For <br />Owner Phone <br />DO NOT S9RITP. BGLOl4 THIS LI:4E-FOR CITY DSE OS7LY <br />Date ^.eceivc3 __ U:.e 7.one <br />Plan CSeck Yumber <br />Valuation <br />Pemit Fee <br />Plan Check Fee <br />Tota] Fee Due _ <br />Datc Issuc:l <br />Fire Zonc <br />Occuoancy Group _ <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />