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-" DUILDIrc PERMIT APPLICATTOII • . : • .. , � ,t <br />' Applicant To Complete This -'orm • �•% , / <br />IP more than one buildingis to be contructed, submit a separate ' , — s P Permit applicl - <br />tion for each building. .1 separate permit will be issued for eacli building. <br />Diner 0P.L Building address 1 45,o 5 o U1 q «' <br />Addresses '' / Lot Block <br />Cif.- ` ; Pho I' X'(v bd' rl <br />y ne .0 iv5 on ( at) <br />Architect/Eaginecr <br />city Phone .Metes G Bounds (Unplatted) <br />•;,•. Contractor '�.' .r'e /��_ Sec.��]wwp. a nge _ O .. <br />_ •': _ - <br />- .ZLdress (/ 3 - 00 Z <br />f City elezz,27- Phone " 7 ' `Dui.lding Use ••ti <br />•• State License Number 2x.3-i'7907y Describe Work to Be Done- '.•`' • <br />1iration Date 73 <br />• *.~' SIMMI PLOT PLMII BELOW' <br />Use of Building <br />a LIItaew ❑ Addition ❑ epair/RemoP.el <br />`•; valuation of Construction $ <br />_PLOT PL1U4 REOUIRT_.L^.NTS <br />R ' <br />Indicate lot size, name of streets, <br />-indicate location and width of <br />{r�••' allays, 'locate proposed and all <br />I existing buildings, sho.J distances <br />1 ? - •a v' - to property lines, si,ow distances <br />? .between buildings. <br />-d !9 0 Lot size 3 x !2 <br />�� Lot area 7h a 0 Sq. Ft. <br />'Size of Bldg. I_f4 So. Ft. <br />'i P• Ilumber of Storir_s <br />y Basement At n <br />.'.. _ �J <br />•:. ' )(Signcd By <br />i'or <br />Owner Phone <br />DO N01 WIM: B?1',0I1 THIS LINT -FOR CTTY USi' ONLY <br />Date Received Me Zone <br />P13n C:icck :lur..bcr <br />Valuation <br />Permit roe <br />Mn Chce). Feo <br />Tctal Fee Due <br />Doc Is::ucd __ <br />Fire Zone 3 _ <br />Occuuancy Croup <br />Typc of Construction JL -I1-P- <br />Occupant Load <br />1^,prinlacrs Yt��7�red rvr-IZFTT • <br />Ai'PR0V6D, r0RJjUI0INC P6RMIP6RMI+T+� <br />Date BV <br />n <br />