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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />II more than one building is to be constructed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />building. <br />Ownsr.,k/?%i; /3 J. 2- �, i. Building Address %3% k A/.(. -. 4 <br />Addressl7I! r„ 4z ,yc�r Lot/5a-/G Block 3 �yG+ <br />city Z--A,e." 'd Phone Subdivision (Plat) %1jI L_�NL r• <br />Ar*tect/Engineer <br />City 6fEeT1 Phone Metes L• Bounds (Unplatted) <br />Contractor SfAiz Hrrr..I )` See._Twp._Range <br />Address.s ' <br />�3 <br />Cityp-�,..C;V Pbone-34}-)27i Building Use <br />State.License Number_Ja3-p/-0a,6 '- Describe Work to be Done a Re <br />Ezpiration Date , S —! / — -v 3� <br />SKETCH PLOT PLAN BELOW <br />�a777-e- <br />'Useof Building' <br />n New 12Addition air/Remodel <br />Valuation of Construction $ OC9 D 0 <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of alleys, <br />locate proposed and all existing <br />buildings, show distances to prop- <br />erty lines, show distances between <br />buildings. <br />Lot size x <br />Lot area ;q. Ft, <br />Size of Bldg. Sq. Ft. <br />Number of stories <br />Basement n�1 <br />Signed By/ji ��t..... L'•J.,. i(`.' G Date 2 - 2 7 <br />For <br />Owner Phone <br />DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY <br />Date Received- ; Z7' 7 Uwe Zone <br />Plan Check Number <br />Valuation <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due s-s • C7-� <br />Date Issuedv" <br />Fire <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />