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DDILDIf7G <br />i)pplieant <br />PEiU'IIT APPLICATION . •� �•�j,!` •r' t �— <br />To Complete This F? �t <br />/ <br />:'orm J' <br />If more than one building is to <br />for <br />be contructed, submit a separate permit applica- <br />tion each building. A separate <br />permit will be issued for each building. <br />• O'+ner � p 1{ p ` <br />1.1 �,,, � <br />/ <br />Building Address !� % :Z'f - % i1 i r4, <br />' <br />. <br />Address <br />, n-d <br />., - <br />lot ji +/ 2 nleex o =ID- o a , <br />City <br />rrono <br />Subdivision (Plati <br />lxchitect/Engineer <br />i <br />City <br />Phone <br />Ifetes L L'ounds (Unplatted) <br />Contractor Aa.' <br />lw y t to us <br />Z` Sec. TWp. Rge <br />lddress <br />. <br />i <br />--4ity <br />.Phone <br />Building Use <br />.F <br />State License Number 1-2 -p -/0 %7S Describe Work to Be .Done jhe•-S';�et�05 <br />.I <br />Expiration Date <br />t, <br />,()k/ <br />• ��' <br />'~ <br />SF.ETCH PLOT <br />PL70N BELOI-I <br />' <br />_1 <br />Use of Building <br />i <br />•s <br />�itew ❑Addition cpair/Remo:_al <br />.i <br />' <br />•' / <br />Valuation of construction <br />""•' <br />:;FIAT PLAT: REQUIRLIENTS <br />w <br />' <br />.Indicate lot size, name of streets, <br />-Indicate location and width of <br />alleys,'locat-e proposed and all <br />existing buildings, show distances <br />f <br />-.L•o property lines, show distances <br />s <br />between buildings. <br />' <br />Sot size x <br />. <br />- <br />Lot area Sq. FL-. <br />�` <br />.:• <br />Size of Lldg. So. Ft. <br />i <br />Number of Stories <br />•f <br />Basement <br />.,; <br />Signcd, By <br />For <br />Owner Phone <br />DO NOT 14aITE BELO" THIS T.viF-?OR CITY USE. ONLY <br />Date Received Uce•zone <br />Plan Check Number Fire Zone <br />Valuation Occupancy Group <br />Pcmiti I'ee <br />Type of Construction <br />Plan Check Fee Occup711t load <br />'4001 Fee. Due _ Spri.nklcrs Required <br />Date Issued <br />