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BUILDING PERMIT APPLICATION 1 fy/ *Ia. <br />l <br />Applicant To Complete This Form <br />If more than one building is to be contructed, submit: a separate permf46 applica- <br />tion for each building. A separate permit will be issued for each building. <br />M�e� /. <br />Owner L•;µ Mc,� we Lj_jk IwL . Building Address its K&firj .•_._ 9'_ u ;- <br />Address «zj� -KS'Itt NcLot -tie Block occ-o- <br />City kA"W"�^u.E Phone E$ [ S'L 71 Subdivision (Plat) Twt—rY Z10 1 <br />Architect/Engineer — <br />"� city — Phone — Metes s Bounds (Unplatted) <br />Contractor aE;tj G :aT JS1I1H, Sec. Twp. Rge <br />Address "lqo% Slw9 D2 N C. <br />City MAVt"svitiC_ Phone 6s 1-6)6B Building Use House <br />.State. License Number az3-aDescribe Work to Be Done <br />Expiration Date Ne.••. �35'+C T, eti oof- <br />• r° <br />SKETCH PLOT PLAN BELOW <br />Use of Building <br />- - ❑Nev ❑ Addition 0 Repair/°RHBfflCi <br />{ _ Valuation of Construction $ SOo <br />1 <br />it ' • ; ---t <br />J <br />1 <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size 6c' x <br />Lot area Sq. Ft. <br />Size of Bldg. j?, , r' _ Sq. Ft. <br />Number of Sto%: es 1 <br />Basement <br />•''� Signed By <br />' ' For <br />M.64ZVLts.ia j %VE Owner Phone eCti q <br />LINE. -FOR CITY USE ONLY <br />Date Received �12_117 S Uce Zonc <br />Plan -Check- "Dumber Fire Zone <br />G <br />Valuation `�C� ` <br />Permit Fee S �G <br />Plan Check Fe, <br />Total Fee Dr.e Sr <br />Date Issued <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />