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. . . - - � --- -- - - -- <br /> _. . . . -- - �-- — ---- . <br /> -- -- - - - - - �:/� - i�. : <br /> BUILDING PERMIT APPLICATION .._��' • ��� <br /> Applicant To Complete This ?orm `' �///�� <br /> If sore than one bu'_lding is to be contructed, submit a separate permit applica- <br /> tion for each buil3ing. 11 separate permit will be issued for each building. <br /> pwner �N; �-� �ii�yh^,pf E Building Address 77G"/��.i,�,cr= ST, <br /> Address 770/ �j�}�/U/E2 �`i. _ Lot �� Block w <br /> � ���L�G�.. <br /> Cit � ��lL � Q,f� �—�f`Jl'eZl'. � <br /> y E�r Phone Subdivision (Plat) � ^ � <br /> ALChitect/Engineer �� � <br /> City Phone Metes S Bounds (Unplatted) <br /> Contractor f'U.e:,C,ETT /j=� I L Oc%' S Sec. 'iWp. Rge <br /> Addzess �i7(• ��'rP.LnF�� wA ;' . <br /> tr✓ 'rc TT �� <br /> City �-.,� Phone j.s'3-7/4 i Building Use <br /> State License Number ?23�0/ -E6�-CR-Ed Describe Work to Be Done �E"h7�D�'�- � � <br /> 3r i-i'�f <br /> Expiration D�te N-/ - �7 i3 %t r.0 �rx n� <br /> SRETCH PLOT PL71N flELOSQ <br /> Dse uf Buildiny <br /> � ❑New ❑ Addition ❑ �epair/Remodel <br /> � � Valuation of Construction S <br /> � . PTAT PLAN REQUIREFIENTS � <br /> • Indicate lot size, name of streets, <br /> indicate location and width of <br /> � � alleys, locate proposed and all <br /> existing buildings„sho�v distances <br /> � �• . to property lines, show distances <br /> � . betwecn buildings. <br /> Lot size x <br /> - Lct area Sq. Ft. <br /> . � � � Size of Sldg. Sq. Ft. <br /> Number of Sto�ies I <br /> � Basement i <br /> � Signed-3 � <br /> �V\r <br /> For �� � � ��ner Pnone �',F-���70� <br /> � <br /> � <br /> DO NOT WRITG BELOI9 THIS LINE-FCR CITY USE Ot7LY I <br /> Date _eceiced U�e Zone � <br /> i <br /> Flan Chec't,y`17unber Fire 2one ' I! <br /> N� � <br /> Valuation ��L�il. � Occuoancy Groun <br /> Pemit Fee Type of Construction <br /> Plan Checl: Fc� Occupant Loa3 ( <br /> Total Fee Due Sprir.klers Require3 I <br /> • I <br /> crr�r r:�- �-��� �� - � <br /> �at� �s�u�a - i <br /> ar-r-r.o���.�� r�,; �..�.�. �;;.,, � , , <br /> i <br /> Date_ '�.' . - _ __— I <br /> I <br />