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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more than one building is to be constructed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />building. l o <br />Q.r.- Buitdin Address �%iaS \�t�Q �-� 2k' <br />Owner �'1 tAAfrL2 <br />L_.b _ %f L.._ Block fI. ';O <br />Address <br />Subdivision (Plat) <br />City vilyti,=— <br />Architect/ Engineer <br />City _� Phone Metes & Bounds (Unplatted) <br />-��it`-��9-��Sec.Twp._Rantye <br />Contractorpu ' g <br />State License Numbers � ,-//Ihy Describe Work to be Done <br />Expiration Date (-- <br />SKETCH PLOT PLAN BELOW <br />Use of Building_ <br />II New ❑ Addition &<ep1irjRemdcl <br />''''p0 <br />Valuation of Construction $ "Q0- <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of alleys, <br />locate proposed and all existing <br />buildings, show distances to prop- <br />erty lines, show distances between <br />buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg._ Sq. Ft. <br />Number of stories <br />Basement <br />Sign Date <br />::� <br />For " <br />sk <br />Own%r Phone <br />i <br />Date Received .r7 �• �y Use <br />Plan CheckNuumber Fire Zone <br />Valuation ^�-TL)� Occupancy Group <br />Permit Fee i Gq6—L�:) Type of Construction <br />Plan Check <br />Occupant <br />Total Fee Due 1� Sprinklers Required <br />L� <br />Date Issued_ <br />