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?PILDING PERMIT ..PPLICATION � `� /��� <br />� Applicant To Comple[e Thir Form i j �- � <br />L-;/„�-s� <br />If more than one buitding is to be conetruc[ed, submit a eeparate permit <br />applieation for each building, A separate permit will be issued (or each <br />(� r— o <br />Owner-�__ ���( ;t��-� .��('C���. �;�. ��� Building Address <br />Addrese - � 1� �� U'.:� <br />�����,���� � � ��Clll �,�Il�) LoE �1�,°- ��IBlock �c��,J. <br />(' <br />Cityr-�•.I S�a �: � Phone��,��ra -�C'OSubdiviaion (Plat) r. 1 1 �'�, �-��'�� ;n �� `�� �� (� ` <br />_ I� � — <br />Arehitect/Engineer ' ( �j �)�(� {1 �. <br />City - Phone � � � Metes & Bounds (Unpiatted) <br />( � � <br />Contractos' l)'l�,y�i{��� c��U�Q(�91,'� Sec._Twp._Rangc <br />,�^ ^ <br />Af3lITf�Ali��l-�I� �� i�Jl��i� /�(1 M I \ �l . <br />Ci <br />- l l� Building <br />State License NumbeFyl�� (�� ��'-%�'�� Deaeribe Nork to be Done ,�������� ��_ �._�n: ;� ��A <br />Expiration Date l�-, — 7'� �'� l �1 �. <�����..� � �, . ��� �`11.�' � . `�.� l ` ' �� `('�� n p . � <br />'� <br />SKETCH PLOT PLAN BELO�Y <br />Dzte Reccived �' <br />Usc oC Building <br />i <br />CI Nev,� L] Addition [�]Rcpair/Remodel <br />Valvation of Construction $ ��R�(�. �� - <br />PLOT PLAN RLRU'�.REMENTS <br />Indicate lot size, name of s[reets, <br />indicate location and width of allcys, <br />locate proposed and all ex:sting <br />buildings, show distances to prop- <br />erty lines, show distances belwecn <br />Uuildinss. <br />Lot sizc <br />Lot arca <br />Sizc of Bldg,_ <br />NumUer oC stories <br />Sasement <br />r <br />Sq. Ft. <br />Ft. <br />Signed By., Datc <br />For . � �i-� i., � ..�� �\ . .. ��ti � <br />Owncr Phohe <br />CHIS LINE - FOR CITY USL ( <br />Plan Check A`umbcr --- <br />Valuation J � (� / U � U <br />(`C' <br />Permit See � � � <br />Plan Check Fec <br />To[al Fcc Due ��. �, 0 �'- <br />_ __ ' <br />Datc Ie�:ucd_, �' �1. �% � <br />i � <br />U6C <br />Fire Zone <br />Occupancy Group <br />Type oE Construction <br />Occupant Load <br />Sprinklers Required <br />