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' BUILDING PERMIT APPLICATI09 AN <br />- <br />} <br />Applicant To Complete <br />This Form <br />' 1 <br />! <br />If more than one building is to be contructed, <br />submit a separates pe-m!L applica- <br />tion fo- each building. A separate permit w'_ll be issued for each building. <br />Amer f4-L,4,-> <br />Building Address <br />' <br />_/)7 <br />Address '4 (b I la v / `� I e-+-�J (� <br />Lot Block . <br />i <br />City c '= (7 - ;Y Phoned-S7 ^ 0557 <br />Subdivision (Plat) <br />Architect/Engi.neer <br />• ^'� <br />-i <br />City Pbone - <br />Metes c Bounds (Unplat.ted) <br />• <br />'-- <br />Contractor 1 `' <br />See. TwP. Rge <br />-- <br />- <br />Address <br />j <br />City Phone <br />Building Use <br />•`) <br />yj <br />-'''" <br />State. License Number <br />Describe Work to Be Done •` <br />;I <br />Expiration Data <br />y1: <br />� SRETCR PLOT PLAN HELOt4' <br />ey,-ate <br />Use of Building _ <br />=� <br />13New ❑ Addition Repair/Remodel <br />x i <br />:: ro <br />Valuation of Construction $3 & <br />PLOT PLAN REQUIREMENTS <br />r <br />• <br />Indicate lot size, name of streets, <br />. .! <br />- <br />-indicate location and width of <br />•' <br />•- •• ?;,.• <br />- alleys, locate proposed and all <br />•.,-'� <br />existing buildings, show distances <br />• �•�-, <br />'.,,�:,-_._:,� <br />to property lines, show 2istances - <br />.1a <br />between br;ldings. <br />Lot size x <br />Lot area Sq. Ft. <br />• <br />Size of Bldg. _ Sq. Ft. <br />` <br />! <br />Humber of Stories <br />..� <br />.. <br />Basement <br />�.. <br />` <br />Signed By <br />+ <br />For <br />' <br />Owner Phone , <br />- <br />- DO NOT ICZITE BELOW THIS <br />LINE -FOR CITY i1Si: ONLY <br />-". - <br />'7 <br />Date Received !� _ <br />Ore ; Zone - <br />Plan•Check :lumber <br />Fire Zone <br />Valuation 3 ���" � <br />pccuoancy Group <br />' <br />Permit Fee - �. <br />Type of Construction <br />Plan Check Fee <br />Occupant Load <br />�j C9C) <br />Sprinklers Required - <br />Total Fee Due <br />Date Issued <br />`S <br />