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a <br />; � � 80ZLDING PERMIT TPPLICATZON � � �� ' '-' , <br />: ' , IIpplicant To Complete This ?orm /� -Z g �'i <br />.��z�� <br />• If more than one building is to be contructed, submit a separate permit applic - i3 <br />., Liort for each 6uilding. �l separate permit wil.l bc issued for each building. <br />. . Ovner ,' L..� �,i �'�•� ti. Huildinq Address �OC�1 �L�:tYr,.;v : 1 ��/` <br />, Mdress �cc'�L '� , :�.n. . Lot l,� � �.3c' Block �l �% ' <br />. City (�"vr:,-�% L_�,; Phone - Subdi4ision (Plat) � <br />' • )�rchitect/Enqineer � C-ri-f'i•� c 1--k !_t . • <br />"� City Phone Hetes i bounds (Unplatted) <br />_f <br />�- .,� Contractor �1 �//,'Sp,v" Sec. 7Mp. Rge � <br />_ 1lddress 65�� G��:v.v,- �i. � _ ' <br />T <br />�' City ��-�. "J'/- Phane u � ..S' -�8"�-' Building Use yo,v c � � •; :� � � <br />^., � , <br />-;� State License Na�aber ���- p/ -/��,� �j Describe Work to He Pone / �cp�� , `�'� <br />.. •. . _.T_`_ - <br />� : I �piration Dat� _ ' �i��, ' <br />:�' � � SRETCII PLOi PLAN BELOW' • - <br />t <br />. � • . <br />; . Ose of Duilding <br />' � • ..� . �., , . []New ❑ Addition �epair/Remo�el <br />• _ 1 . � • � . � . u t� r. <br />� Valuation of Construction $ SC�: — <br />I <br />� i <br />! <br />: -'j <br />; '� <br />a <br />�` <br />� <br />PI,OT PLAN kEQUIREh1ENTS .. <br />Ixidicate lot size, name of streets, <br />-indicate loca:ion and wicth of <br />alleys, locate pr000sed a,^.d all <br />existing buildi ;gs, sho:a d:stances <br />to property lines, shew distances <br />betveen buildings. <br />Lot size x <br />.Lot area Sq. Ft. <br />Size of Bl.dg. _ Sq. FL. <br />Number oE,stories <br />Pasement � <br />Sianed By � , f �.� i <br />For ' <br />'Owncr Phone <br />DO :IOT tiZ?TS DELOI! THZ"s I.I:dE-POR CITY JSE O:IL'I <br />• � . <br />Date S�ceived ' � Ute 2onc <br />P:an C:�eck `7ur.,Ser � � ' ' Fire Zonc ' <br />, : �. . <br />Valua�ion � Occuoancy Group <br />�` �.. <br />Pemit Fee -�� Type of CcnsCruction <br />Plan Check Fee - ' Occupant Load <br />1bta1 Fee Due ' Sprinklers Required _ <br />Datc Issaed � Fn�L-�/�7 � • , - : . . - <br />/ � • <br />