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� <br />BUILDING P�RMIT APPLICATION <br />Applicant To Comple[e This Form <br />If more than one huilding is to be construc!ed, submit a separate permit <br />application for each buil�iing. A separate permit will be issued [or each <br />building. - <br />���'a / <br />3�y���/ <br />� Owner��7'��'� � �r^'f�."�''f' Building Addrese ��,� �' � �iIr��'1 "//G/� • <br />'r �7 / �,„/�/C /atG Lf-f—/! ��� <br />Addrese/�/ �/ �s.' i� r�� � Lot c,t_ < Block �� <br />/ , , ��j �` .: � j': .',, i`i <br />City !%/f��✓C� Phone,3J � ��/,S<�Subdivision (Plat) '� "' <br />/ � <br />Architect/Engineer��( -�' . <br />City Phone Metes & Bounds (Unplatted) <br />Contractor S�• �c (� ' Sec._Twp._Range <br />Address � <br />City Phone Building Usc ;-nG�/1/f�� `.i�� <br />i j. � <br />State License Number � - Describe Work to be Done <br />1����'- �: - ��r <br />Expiration Date '��• / �?�� — <br />SKETCH PLOT PLAN BLLON <br />�, � i . <br />���'-��v�w Uee of Building • � <br />,( <br />�v io <br />� <br />.�New ❑Addition []Repair/Remodel <br />Valvation of Gonstruclion Q 3� <br />� PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indieate location and width of alleys, <br />%� ,� loeate proposed and all existing <br />buildings, show distances to prop- <br />erty lines, show distances beCween <br />buildings. <br />Lot size X, <br />Lot arca Sq. Ft. <br />Size o[ IIldg. Sq. Ft. <br />Number of s <br />� Basement <br />' �� � �%�� �'�.✓d�� �z /�/�: <br />Signed B / �i �/- c. / i ; � <br />�.- -- / T. �, <br />For <br />Owncr Phone <br />DO NOT \VRI7'k. tlLLOW THIS LINP•_ - FOR CITY liSE ONI�Y <br />1 � - a- <br />Date Reccived ,�( - � �1 - % �� Use 7.onc ��' <br />Plan Check Number Firc Zone_ # Z <br />C�i <br />ValuaLion j� ,�-.>ti� Occupancy Group i-1' <br />J= k h-� <br />Permit Fee � 31.:. Typo of Construction <br />Flan Check Fee (� b y Occupant Load <br />Ut' <br />Total Fcc Due ZJ `t' Sprinklers Required <br />Datc Issucd <br />�� <br />� <br />u <br />a U <br />H � <br />W z <br />� d <br />Lil =l T <br />W � Q] <br />G, � i ` <br />O <br />} L•_ <br />F- . <br />i:. <br />L L: <br />C� <br />�'- <br />� v <br />a � <br />¢ o <br />