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• — BDILDINC PERMIT APPLICATION • J�/ � — <br />Applicant To Complete This :orm / 'd <br />If more than one building is to be contructed, submit a separate G/ ! p permit applica- <br />lion for each building. <br />A separate permit will be issued for each building. <br />OmerC� l i.��'?/ Building Address <br />, <br />' Address %% / �/ �„,..i Lot <br />•'+ Block - <br />City �7�2t Phone g'S�'7� %� Subdivision (Plat) : <br />Arahitect/Engineer <br />City Phone Metes i Bounds (Unplatted) <br />:.' Contractor 2; Sec. TWP• RQe <br />J' Address T <br />!. City Phone Building Use <br />State.License Number Describe Work to Be <br />>trpiration Date <br />_ {! SIOrTCB PLOT PLAN BELOW <br />.. p1 - •- <br />• Use of Building � <br />JL <br />i 13New ❑ Addition Repair/Remoi,el <br />.i• !� �. <br />i - Valuation of Construction $ <br />• PLOT PLAN REQUIREMENTS /5��•_ <br />Indicate lot size, name of streets, <br />' indicate location and width of <br />•'�. -:' -t• alleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />9 i e between buildings. <br />;• Lot size x _ <br />.i- Lot area <br />. Sq. Ft. <br />i• e- Size of Bldg. sq. Ft. <br />• ' „ Number of Stories <br />1 Basement <br />Signed By / <br />1 For <br />Owner Phone <br />Iii BELOW THIS LINE -FOR CITY USE <br />-- —. Date Received 1p//3/7) ^ Dce Zone <br />Plan. Check Number Fire Zone ' <br />Valuation�G o <br />/��-Occupancy Group <br />Pewit Fee /S• Type of Construction <br />Plan Check Fee Occupant Load <br />Total Fee Due /— Sprinklers Acquired <br />Date Issued �` <br />