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c <br />/ <br />: BUZLDSNG PERMIT F�PPLICATIOY / Gj/�� .�� <br />_ � Applicant To Complete This ^orm � <br />5���� <br />� If more than one buildinq is to be contructed, submit a sepazate permit applica-' <br />' �'tion for each building. n separatP permit wil: be issued for each buildinq. <br />O�met /���� - � Building Address � " �% <br />. Address Lot ' Hlock <br />City Phone Subdivision (Plat) <br />Architect/Enqineer <br />_ City Phone Metes 6 Bounds (Unplatted) <br />, Contractor � ; - Sec. 7ti+p. Rga <br />Address , - <br />City ! ��'� P." Phone Cu3lding Usz � <br />,� State License Number -" �� '� � Describe Work to Be Done ����"� � ' <br />�. Expiration Date � �%�'/ /c� � - � � ' � <br />SRETCN PLOT PLAN flELOiQ <br />,�C: ,,: i=� <br />1 / <� T ' � P7o' ; �.,., / <br />Qse of Buildinq � <br />�New ❑ Addition YJ xepair/Remodel <br />Valuation of Construction $ <br />•� PLOT PLAN REQUIREhfENTS � <br />• Indicate lot size, name of streete:, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Nunbex of Stories <br />Basement <br />Signed Ey _ ' � <br />Foi r <br />Owner Phone <br />Date ?`.ecei�,•ed �/�/ �,� <br />—r �-- <br />P.,n C:-:ec:: ::�nce= 7 .�-� - 'L�'J <br />ir._�.,��ior J ��f�C_`� ' �'� <br />.�/y !'1 f� <br />Pemit f'ee -r _ <br />Plan Chec): Fee ( Z, � � � <br />Total Fee Due �'J 4 - � � <br />�' <br />Date Issued ��-7 <br />ti:e 2cne <br />Fize �cne 1' <br />nrrnna�r�� rrr.��o �' — Z <br />Type �f Construction <br />Occupant Load <br />Sprinklers Required _ <br />. . cirY oF �vErt n <br />APPRU'JED FOR QUILDING PERhUT <br />Date��;l.� 1 � _ . Ry _ -� c <br />