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-_ --- - BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more than one building is to be contructed, submit a separate permit applica- <br />tion for each buil ing. A separate permit will be issued for each building. <br />Owner ����••{{•� Building Address i'!�Z1�7 G <br />Address J44- Z '%t-V_cx1' Lot Block <br />Architect/Engineer <br />City Phone <br />Contractox���c <br />Address x ra, Pc , mc,km <br />City El)Fnc Ph ne <br />State License Number M3-G/-//`Vt2 <br />Expiration Date 6, • Cr) •- 1 J <br />SKETCH PLOT PLAN BELOW <br />Subdivision (Plat) <br />Metes s Bounds (Unplatted) <br />Sec. Twp. Rge <br />Building Use <br />Describe Work to Be Done <br />t <br />4UseBuilding �,,,�!��n��+� <br />❑New [I Addition NSxepair/Remodel <br />• en <br />Valuation of Construction <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings,.show distant-s <br />to property lines, show distances <br />between buildings. <br />Lot size <br />Lot area SH <br />Size of Bldg. Sg <br />Number of Stories <br />Basement <br />Signet By <br />For <br />Owner Phone <br />DO NOT WRITE BELOW THIS LINE -FOR CITY USE ONLY <br />Pp <br />•fnatc cceived �1't 0-7p ULe Zone <br />4 Plan Check Number _ <br />X Valuati.on _ <br />r� <br />APermit Fee /o-? <br />4 Pian Check Fee <br />.*Total Fee Due <br />A Date Issued <br />4 Fire Zone <br />-P Occupancy Group <br />4 Type of Construction <br />4 Occupant Load . <br />f Sprinklers Required <br />Ft. <br />Ft. <br />CITY OF EV_; l <br />APPROVED FOR DUILC;i; a r7_r IT <br />Date— Dy — -- <br />