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� BUILDING PEf2MZT APPLICATION <br /> ; Applicant To Completc This Form <br /> If mor.e than one building is to be constructed, submit a separate permit ap- <br /> plication for each building. A separe.te r�rmiL• will be issued Por each build- <br /> i.ng. _1 <br /> � �� � _��/' ;' /c o i 7,>L.__ ct� <br /> Owner•"%��✓ > �t/4-�--� 33uilding Afldress � t' . <br /> . � n � <br /> Address � e rr i �� �-�%�`-�_ Lot IIlk._ Se�._ <br /> c - <br /> City <='-'�«_� Phone ' Twp. Rge. ' <br /> Architect ' Subdivision (Plat) E� -pi� ,vitJ / <br /> City Phone Metes 6 Do�nds (Unplattad) � -� �� <br /> , i <br /> Contractor ����i.�,y.t,�-�� L.,-�.�l.- ��� �3 0 �l� :U 'z. ;' .;:-ic„�v � l� 2 <br /> V <br /> Address ✓��r�'��.7-o i�J- <br /> ` <br /> City G�--eit,<vG� Phone .'� �- ��: =��-2- � - _ <br /> 1 Building Use .�-c-t�-�- �-� ��.� <br /> - State Licence Number- -� 1 3--e'/ - G��� % DescriLe S•Iork Co IIe Done ����:1-,-«...-�- <br /> � !/ <br /> £apiration Date �1-c-!��•-ti� .��_,-s ��•..���,tj . . <br /> /n <br /> Use of IIuilding_ L�.�.ti_�(: -: : .� <: � / : <br /> .J <br /> � '�New .. Addition . Rep 'air� Re�odel <br /> Valuation of Constructi,on $ �t�OC -- <br /> � � � PLOT PLAN <br /> � Indicatc lot size, name of streets, <br /> - indicate location and width of <br /> alleys, locate proposed and all <br /> � .� existin9 bnildings, �how distances <br /> to property lines, sho�v distances <br /> between buildings. <br /> Lot size x ! <br /> ' � � Lot- arca — S.I'. ! ' <br /> . � Size of 131dg. S.F. i <br /> Number oL SCories � <br /> llasement <br /> ' Use 2one � , <br /> Signed Dy � .�� /��, r_.,l/ � <br /> � � For � � ��lL :Ja-,c, �� ��'�-,� c�: �, <br /> '----� -- <br /> Owner <br /> DO NOT R'RITP•. RELOIJ TIIIS L7NE-POR CITY USE ONLY <br /> i <br /> Date Received � 3 Fire 7.onc <br /> Plan Check Numbcr � Type of ConstrucLion <br /> Valuation ��jar���- -�— Occupancy Group <br /> Permit Lee C� _ �v Occupant Load . <br /> Plan C1�eck Pee Sprinklers Required <br /> � Total Fee Due � , � - - � � <br /> Pelmit Numbcr � ' , . <br /> Date Issucd��3r�7 ) . . <br /> i <br /> APPROVCD FOR DUIIDItJG PCRMIT ' <br /> Date_ .. <br />