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� BUILDING PERMIT APPLICATION <br /> � Applicant To Complete This Form / �/`� � j � <br /> 0 <br /> If more than one building is to be construeted, aubmit a srparate permit � <br /> applicatior. for each building. A separate permit will be issued for each .3/s/> <br /> buildiny. � <br /> � <br /> Owner � �� f7 . 'Z � Building Addrees Y� � � - � P_.�t�. <br /> � <br /> n <br /> Addreee '� Q f .r, �� Lotc�J V a,C�Block .3 �-�`� � - " <br /> \ �� <br /> City � LS ' ; ���Ph l�e J� Subdivision (Plat) � I, �U�f >.:`�` �w' - � <br /> \ T <br /> Architect/Engineer - <br /> City \ Phone�_ Metes & Bounds (Unplatted) <br /> e , <br /> Contractor��\�('� �� 1 l l�LQ�l�.4.-��Sec. Twp._Range - <br /> � r. <br /> . Addreas , � �/1 r �1 � n . <br /> City ` T • � r Ph ��� ����� ��suilding Use � � <br /> State License Numbe � -�� � �OLescribe Work [o be Done <br /> Expiration Date `��- { ����iL�ln � � L�-'7l\��� �-��'�C9CL-`'l� <br /> � ° <br /> SKETCH PLOT PLAN BELON ��'1 `l1\�hC���.L��4_1� �l ��G`i_C`1�:�. <br /> � Use of Builaing� <br /> .Q New CI Addi[ion f��pair/Remodel � . <br /> � /� ��o <br /> Valuation of Construction $ � � �` , , - <br /> PLOT FLAN REQUIREMENTS <br /> Indicate lol size, name of streets, ' <br /> indicate loc�tion and width ot alleys, <br /> locate propoeed and all existing <br /> buildings, ahaw distances [o prop- <br /> erty lines, shcw distances between <br /> . bui:dings. <br /> Lot aize x <br /> Lot area Sq. Ft. <br /> Size of Bldg. Sq. Ft. <br /> Number of storiea <br /> Basement <br /> Signed By Date . <br /> � For <br /> - Owncr Phone <br /> DO NOT WRITE BELO\V THIS LINE - FOR CITY USE ONLY <br /> -7 � <br /> � Date Received � � � / S Use Zone - <br /> Plan Check Number Fire Zone <br /> Valuation �`:� l`�o C��\� Occupancy Group <br /> Permit Fee 2 �• �� Typc of Const:'uction <br /> Plan Check Fce Occupan[ Load <br /> Total Fcc Due Sprinklets Required <br /> Datc Iesved � <br />