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< < � <br /> /�� �� <br /> IIUILDING PER::IT APPT.ICATION <br /> Applicant To Completc Thi, Form ��/i/�,� <br /> If more than pne building is to be constructed, submit a separate permit ap- <br /> plication� for���ch buildi�eg. A separate permit will be issued for each build- <br /> ing. LL,��,t.,l -� Q � <br /> � � � � "� -� � / � � / � <br /> Owncr \. � C� �� �� • C_. ��r'% .� IIuilding nddress �i� �J ��� �'L-/�'��'� <br /> --7� / <br /> Addressl��"i��� •✓1,!'�.. ' Lot�/^l� IIlk.�3� `��sec. <br /> City ��� _ Phone�✓ J`�,.iC���}� Twp. Rge. ' <br /> Architect ' � Subdivision (Plat) �Z:, ��, � <br /> City Phone AfeLes G Dounds (Unplattedl <br /> Contractor f/ (� <br /> ( <br /> Address <br /> City Phone IIuildin9 Use ° .t, _ <br /> State License Number' � ' bescribe Work to IIe Done <br /> r jI /�/� <br /> s>:pication D�tr_ ��1�' �f_/��--� �i' ii%i 4�1.(r', i-yP�(AC <br /> �' <br /> I �/ ^ <br /> Use of 13uilding� 1 . /f ` « ���t- <br /> � �� '�New . . Addition , Repair/Remndel � <br /> ' �--1,0 � ,%/�? , <br /> 13 Valuation of Constructi,on $ . "� <br /> � � . PLOT PLAN <br /> r� <br /> .� � � Indicatc lot size, namc of strcets, <br /> v f a 5„ZZ,_. indicate location and �vidth of <br /> , �� `.o��f . - alleys, locate proposed and all. <br /> �� � er.isting Unildings, show distances <br /> _�� � - to pzoperty lines, sho�.� distances <br /> ��� bettuecn buildings. <br /> Lot cizc x <br /> � � Lot area S•F• , �, <br /> _ I - Sizc of. 131dg. S.F. i ! <br /> Number of Stories � <br /> ,j, ," IIasement <br /> Use Zone <br /> , � - <br /> -��. Signed Dy�� � I <br /> 1°or <br /> Owncr � <br /> UO A07' 4;RI7'L LItL(�;7 TII]S L7NG-POR CITY USli ONLY I <br /> — i <br /> Uzce Iieceived �-��- �5 � Fire 2one <br /> Plan Check Numbcr � Typc of Co:isCrucl-ia� <br /> Valuation ' Occupancy Group <br /> Permit Pee �7 • L _ Occupant Load . <br /> Plan Check Pee Sprinklers Required <br /> � Total Fce Duc J� ��� ' <br /> Pcrmit Numbcr � � � <br /> � �Z-- 5 � r" <br /> nate Issucd 2��-l/- 7� � � � 7J <br /> APPROV[D FOR [3UILDIf;G PCRMIT <br /> Date_ .. <br />