Laserfiche WebLink
1. <br />1 <br />BUILDING PERIAIT <br />APPLICATION •`i <br />Itpplicant'To Complete <br />This Form <br />i <br />If more than one building is to be contructed, submit a separate permit appli.c3- <br />tion for each building. A separate permit will be issued for each building. <br />Building Address yg��S -. �7 ✓mud i'n,: <br />Owner <br />�) I 5i 2 4 <br />Lot Block <br />Address 7 d <br />`yyJ��,,�� % Phone 3SS-//'5'5' <br />Subdivision (Plat) 61 . <br />City <br />' <br />Architect/Engineer J7 <br />• <br />City Phone <br />Metes 6 Bound_: (Unplatted) - <br />. f <br />' .. <br />i �it.a-.. <br />Contractor .Q ! �CeP.a[ <br />Sec. Twp. RQe <br />� <br />� <br />i <br />-.City s'!% Phone <br />Building Use `w <br />State License Number �z i'D/���5/C� <br />(. <br />Describe Work Be Done <br />�( <br />Expiration Date <br />srETC11 PLOT PL'+'I BELOW* <br />' <br />" <br />Use of Building <br />i <br />E New I,Additi.on ❑Repair/Remodel <br />CIO <br />' A <br />Valuation of Construction <br />1. <br />_ <br />o <br />11TOT PLdhN LEQUIRE}IENTS <br />Indicate lot size, name of streets, <br />i <br />T• <br />-Indicate location and wid:.h of <br />allcys,'locate nroposed and all <br />existing buildings, show distances <br />to propert} lines, show distances <br />between buildings. <br />Lot size x <br />' <br />Lot area Sq. Pt. <br />Size of Bldg • Sq. FL <br />:.. - _ <br />Ilurabc: of Stm:i. es <br />Ha�:•.ment <br />� :� •: -- <br />k• <br />- <br />-_ <br />_ <br />Signed 9y LlQd17LG �� <br />1. <br />lctil¢� U cCv For <br />� s�sas�- _ <br />3SS- N 34� <br />• <br />/y,;,,,i7 <br />Owncr Pholr� <br />i <br />' <br />- <br />DO_ NOT 1:3iTE <br />_LII7E-FOR CLTT USF. 011H <br />/B�LOY <br />Date received 7's 1�_ <br />Use Zone-�_--.-- <br />- <br />Plan Chec:::Iur.,ber ,_-_ <br />Fire Zonc --_.-- <br />Valuation <br />Occupancy Group <br />q�0'_-�� <br />remit Fee _ C - --___. _—__ <br />Type of Construction <br />Plan Check Fee <br />Oceupaut Load <br />—��-----------'- <br />SPrinlJ.iss Requirrcd <br />""-- <br />'Due <br />.iUtal rce _ ..� <br />• . <br />' <br />Date Issued i��7�7is.- ._-- —.-- <br />_ <br />. <br />