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. <br /> ,: <br /> UUILDING PERMIT APPLICATIOD' <br /> Applicant To Comple[c This Form / ����j �_� <br /> If more than one bvilding is to be coostzuc[ed, submit a sc�arate permit ��l <br /> • application for each building. A separate permit will be i3Fued fur each � - <br /> building. `f J . '` :"� <br /> �, . . ' /. .'r ; . . <br /> Owncr �il''�' 1�:��} BuitdingAddr�es ��-t� ��f,' •!. :;fa � ;�� . <br /> Address� "��� ��� r /�' � " ' Lot Block <br /> / r <br /> City�,71i��. � i i Phone � � -�?'l�_7 Subd�.ivisi.�n (Ylat) �/,` ���. /���:y.7: � , � , <br /> Architect/Engineer f%� �� "�i-�� <br /> Gity Phone Metea & Bounds (Unplatted) <br /> /,`J�� .�' 7 ..� � <br /> Contrac[or���' , % � . r� '�i:�' Sec. Twp._Rangc <br /> � '/.�„ �r r — <br /> Address� /,�{%� ��J / _—_ <br /> �/_ <br /> CityK✓(^/L'(]r Phonc�. '�D��ll�vildingUac _ _ <br /> State License Number G7� �DI�0��.'�ti�Desrribe 1Vork to be Done_ <br /> . Expiration .Jatc _)�� �7�� _ <br /> �— <br /> SKP;'TCIi PL07' PLAN Til'I.OAt' � <br /> �� Use of Baildir�__ ��_ �� I��'I . ' � <br /> _� <br /> I �l Ne�v [] Addition I�Repair/Remodel <br /> I „ ,��> <br /> Valnation o: Canstructio❑ S �.�-�5� �'� �`' =i� <br /> 1 , . — <br /> ' - PLOT PLAN REQUIREMENTS <br /> . <br /> � � �� � <br /> � Indiwte lot size, name of strcets, <br /> � '�-� �� indicatc locatio� and width of allcps, <br /> �.. � �� loeate propoced and a�l c�isting <br /> . iA ,x,� �. buildings, show distanccs [o prop- <br /> � � � � erty tines, show distances between <br /> � �I - � buildinqs. <br /> . ' �I <br /> j ,�,' i Lot s;z� 3 ��> X ' �, 3 -- <br /> „ � � <br /> �� � � �'� ���` Lot area ;(- ����' Sq. Ft. <br /> .y. r <br /> _ � � <br /> � �� siz� ot stag. ,� .r.� _�q, Fi. <br /> _ � -� � � - . � <br /> ` Number of stories <br /> _ ` l� j /� r <br /> , Basemrnt�_ ' <br /> ', ' � . . � �' � Signed By��1�'��lN�� v!t( �l'L✓Da[c ��-�_�_',� � 7�' <br /> For <br /> � Owner Phonc <br /> DO \� '.' 14'2ITI: RLLOl4 1'I�IIS I.INE - FOR CITY USF ONLY <br /> Da[e Receiv�=d Z ;�,,,._Y l� Use Zone � - 1 <br /> Plan Check Number ��j -1 Z � Fire Zonc_ S� � <br /> �U OL9G �T� <br /> Valuation_� � Sl�� Jccupancy Group 1 _ <br /> Permi[ Fee �Z j�� 't'31T�- Typc of Construction_ \ - 1�� <br /> Plan Check Fee �3• S� �i.1L�- Oecupant Load_ - , <br /> 'iotal Fee Du� / Q 5� SprinlQers I�equired _ <br /> -> � <br /> Da[c I^sucd -� " \�- �(' S _ <br /> r <br /> l • <br /> • <br /> Y <br />