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' ; � � - SOILDING PEAMIT APPLICATION . �•� , � � <br />-- �• t � -�Qplicant To Complete This Sorm ���✓/�..'1 <br />, •' it more than one buildinq is to be contructed, submit a separate pezmit appl%a-/ `� <br />. tion for each buildinq. A.separate permit will be issued :or each building. <br />/ <br />" Ovner ��� � i �iFt �'� „�'/r , Building Address ��.� /�" � . <br />� J� 'l 1 <br />' rIl <br />, lddress ` 7.� C% �� 3: a c'� ��� Lot �) Biock <br />. Clty � ,�v".'� � Phone --�.s��'�ri� Subdivision (Plat) Ql�/���iUd^c� h�.��1.,7��� - <br />/- . <br />' - lrehitect/Engineer '�.. � ! � <br />`"� City " Phone � Metes s Bounds (Unplatted) <br />- - 'i <br />, Contractor -- Sec. 3t+p. Rge <br />` Eddzess - ' <br />'. ' _ ' � <br />' City Phane _ Buildinq Use ' "':.ti;',,.,, <br />�.; . ...,� ' • <br />�� � �� � State. License Nuc�ber `----- Describe Work to Be Done cC. .� c'� �G >' �'� `� <br />� � �1 L=pization Date -- _ �` A /: n `' �' C' �%7 '� <, . <br />B <br />:1: .. ' . SICETCH PLOT PLAN BELOW� ' - ' � ' <br />' 'i ' ' . . <br />.' .i �- . Use of Building <br />� � { � .. . . :' , � �. , _ . � ❑New ❑ Addition ,[�Repair/Remouel � <br />' � : � . Valuation of Construction S �'��'' � <br />� � � . . . . - P7AT PLAN REQUIRE�tENTS - <br />.� • � . . . . . . � . . - <br />. . , • ' <br />� � • � � _ � � ' � � � � Indicate 1ot size, nane of s:reets, <br />' ' � � � .� � • � �indicate location and width o: <br />. _ � � " ' �. � � alleys, locate nr000sed and all - <br />� i•� � � � . _ existing buildings, show distances <br />•- v .,�v to property lines, show distances <br />� � � ' � - between buildings. <br />' � Lot size x <br />...- ` � � Lot area Sq. Ft. <br />r . � • Size of Bldg. Sa. Ft. <br />�; . Num6er of Stories <br />, �,; , i� � , � Basement <br />s:. ' �_ � � i/ � �-lr� " . <br />`� •: — Signed IIy � '.. � . _� „ r�' ✓4' • <br />. ; <br />. '. For <br />- � � � . Owner Phone <br />- DO N0: Sd:2ITr 3?iOS�I THIS LI:4'c-20R GITY ❑SE Oi1L'f <br />� . . , <br />Date Seceived Dte ZonE <br />' Plan Check :7ur.,ber ' Fire Zone ' <br />Valuation dccunancy Group <br />Pexnit Fee Type of Construction <br />� Ylan C6eck Fee Oecupant Load <br />' Total Fee Due Sprinklers Required <br />Date Issued _ �� � „ . . - " <br />