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� �y �� <br /> BUILD7NG PERMIT APPT.ICATION j���y <br /> ; Applicant To Complete This Form <br /> If more than one building is to bc constructed, submit a separate Pcrmit ap- <br /> plication for each building. A separate per.mit will be issued for each build- <br /> inq. <br /> J' Owner �j,9>fi� �d Jr E A/-S fQC Duilding Tddress i:ri•� fr'c�c�rrrF t.�f� <br /> Address /�/� •k'D�_ f�f fl' l/�li Lot�-�-S Blk. _ 1 9 Sec. <br /> City�Yf�E_'Y7_ Phonel_�-.-�-C<;c•>�--� Twp. Rge. ' . <br /> Archite '- ' - Subdivision (Plat) �!'�'1(A�[�Tr)k�S �J� ��`J � <br /> City Phone tdetes & Bounds (Unplatted) <br /> Contractor <br /> Address <br /> City Phone Building Use �, M � <br /> � State Li.cence Number' � � Describe SJork to De Done fr'�f�,f,i R . � <br /> Expiration Date S / !�/�/� <br /> - � � Use of f�uild�ing <br /> � '—New .. Addition _e ai /Renodel <br /> � <br /> � Valuation of Constructi,on $�"d C' � <br /> � � � PIAT PL1�N <br /> � Indicate lot size, name of streets, <br /> � indicatc location and �,idth of <br /> alleys, locate proposed and all <br /> � . . existin9 buildings, show distances <br /> Lo property li.nes, sho�a distances <br /> between buildir.gs. <br /> Lot size x � <br /> � <br /> ' � Lot area S•r• � i <br /> , � Sir.e of IIl.dg. S.F. � <br /> NumUer of Stories � I <br /> � Dasement � <br /> Use Zone <br /> Signed Dy � � <br /> � � . �i <br /> FOY�,r.a < -+zeo-„c-e.vx_� <br /> Owner <br /> DO NOT WRITG 6ELAW T[IIS LINB-POR CITY USE ONLY <br /> Date Received �— ��- �],� Fire 7.one ' <br /> Plan Check NumUe/�i Type of Construction <br /> Valuation � X Q Occupancy Group <br /> Fermit Fce / � �� Occupant Load , <br /> Plan Check Pee Sprinklcrs Req�.iired <br /> � Total I'ce Duc l� _ � � . <br /> Permit Number T . <br /> Date Issucd d z�_ <br /> APPROV[D FOR f3UILDING PERMIT <br /> ro�� _ <br />