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. .. <br />. ; DOILDING PERMIT APPLICATION �/�5 � <br />• Applicant To Complete This ?orm // C' `/�� <br />Sf more than one building is to be contructed, submit a separate permit applica- �/C``� <br />t i o n f o r e a c h h u i l d i n q. � 1 s e p a r a t e p e r m i t w i l l b e i s s u e d f o r e a c h b u i l d i n q. ��//� <br />Owner J(>(' L�2EL'JIFAF SuildinyAddress ZqZS �Jp��-ro�.l.i iJE <br />, 1lddress �,��D-t �>oLF i A�F Loe i�.+i3 sio�x �0`l9�—�-�- <br />� j <br />. City r . �F'� (' � Phone�-i -"3 y`i 0 Subdivision (Plat) -(-__� .,�'��,-7T" • <br />Architect/Engineer <br />"� City Phone Metes b Bounds (Unplatted) <br />, Contractor ' Sec. '11+p. Rge <br />' 14ddzess ' <br />� <br />City Phone Bnildinq Use �t��T,•�i�T�E {�F'p�a�{Z. <br />,:� State License Number Describe Work to Be Done I�R Ai ��,�� ;� i-;- <br />• i <br />.�: <br />1 <br />_� . <br />E�cpiration Dat� <br />SICETCH PLOT PLAN BELOW <br />�... • � . <br />� <br />. . , '! � � � � � '! <br />� <br />�: <br />; <br />:.. ' <br />�.. —' <br />z <br />DO ;70: lC:2ITL 3ELOFl THIS <br />Date �eceived Q--�� I'7 C� <br />Plan C:�eck :Jur.,ber <br />Valnation 2 S�es �� <br />Pemit Fee CL�. � <br />Plan Check Fee <br />Total Fee Due cs-r-: ��— <br />Date Issued S�-�¢�71 � <br />T <br />d"�r>�n-rlf�q �i- �F_ pAr� <br />. � <br />� Oae of Building � <br />❑New � Addition ❑ Repair/Remc:iel <br />. �� <br />Valuation of Construction $ 2.� L� O• <br />PIAT PLAN REQUIRF1dENTS . <br />Indicate lot size, name of streets, <br />indicate location and wicth of <br />alleys, locate pronosed a�d all <br />existing buildinqs, sho�v distances <br />to property lines, show distances <br />between buildings. <br />Lot size 5c� x I Z� <br />Lot area O Sq. Ft. <br />Size of Bldg. ( �ii Sa. Ft. <br />Number of Stories � <br />easement <br />Signed By 1ti��. � ,.VL��, 5'b ;La- <br />For \<>�� C92i- �<_� ��l' ��i--- <br />Owner Phone <br />Uce Zar.e <br />Fire Zonc <br />Occuoancy Group _ <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />_ <br />'�;'. ' I <br />