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BUZLDING PERMIT APPLICATSON / Q�� O'= <br />Applicant To Complete This ^orm �� v i� <br />��j���; <br />If more than one building is to he contructed, submit a separate permit applica- <br />tion for each buildir.g. 1 separate permit iaill be issued for each building. <br />Owner ���'�G�-, ;=i� ' ' � Building Address � ��<� :%v"v - ' � <br />�� <br />Address G? io '-.,��: . - �- , Lot y- % Block U 9`i� <br />City fr �,i;..� r� �l Phone -, : � - >-•; ' Subdivision (Plat) �`.'i� �l - --..��,,.� <br />Architect/Engineer � (,.,{',��,, � • i '� ; �����f <br />City _ Phone Metes s Hounds (Unplatted) <br />Contractor ' i�•,_-.:_ Sec. - <br />4Wp. Rge <br />Address � � , <br />City Phone Building Use ,��=..'.i,,r..,-.�K � <br />State License Number �'' �,�%/ '� - Describe Work co Be Done /��57. ;7 <br />Expiration Date / �i/�75� � _ �,.. � � 4 S� <br />SKETCA PLOT PLI�N OELOW' • - <br />C �- <br />' � <br />`-� . �_ <br />.,,Y • <br />� <br />� , <br />� ;0• <br />r <br />---- Ose of Building i�-'/-�,�.-�;�.- <br />[aflew ❑ Addition ❑ Repair/RemoGel <br />� Valuation of Construction ����,�-�= f <br />' � PIAT PLAN REQUIREb1ENTS � <br />S Indicate lot size, name of streets, <br />- indicate locatior� and width of <br />� � alleys, locate pr000sed and all <br />� existing buildings, show distances <br />; to pruperty lines, show distances <br />betwcen buildings. <br />Lot s.ize � _5_C' x �.�� <br />Lot area �•,��• � Sq. Ft. <br />Size of Bldg. /p Sq. Ft. <br />.lumber of Stories <br />-`� -- Basement �.. �•p <br />Signed 9y ' .�L;._� , v�.^.,�.....-•-r <br />For <br />Owner Phone , '� <br />_ DO :iJ: ' :i:' - `;i .-�'rI.3 :.-r'OR CiTY 'u5E 02iLY <br />D��te "�ceived �� �-%.S -.•U_e :one <br />F1::� C.`.���_.:: >.�-,._�_ '7.5 -� O Z— Fire �onc - <br />Galuiti ,.; <br />Pemit Fee _ <br />Plan Chec?: Fee <br />Total Fee Due <br />D.�[c Is;:ued <br />Occuoa:tcv Grauo <br />Type of Construction <br />Occup�nt Load <br />SprinY,lers Required <br />/ 1Z�� <br />� /� %� X <br />U <br />