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'_ • BUILDING PERMIT APPLICATION • ,% / �•��"- 1 <br />Applicant To Complete This :orm <br />Zf more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will he issued for each building. <br />Omer/O/n /'i+ ��['� building Address � 20— <br />• Address ,� '20 / Lot �� / D Block C. <br />City 67 U Phone Subdibision (Plat) <br />• Architect/Engineer _ Le"I' Q" <br />City Phone Metes s Bounds (Unplatted) <br />.; . <br />Contractor 2e t' C /.�s ..c ' - <br />i <br />City ef&e rof7V Phone,, <br />' i <br />State License Number S S iS <br />,4&-C'/- <br />1 <br />£rpiration Date <br />SKETCH PLOT PLAN BELOW <br />S. <br />BELOW Tills <br />Date `.iceeivcd 101 ( d <br />Plan Chock Nunber --'- <br />Valuation �� 5_00 <br />Permit Fee ZC c�—�— <br />Plan Check Fee <br />Total Fee Due G. <br />. .. llatC I sued Q �\ <br />Sec. TwP.` Rge <br />Building Usei�t,r_e�2 c.Rl� CYad-: <br />.,••... <br />Describe Work to De Done <br />Use of Building <br />❑New ❑ Addition 'C,Rcpair/Remoicl <br />'Valuation of Construction <br />PLOT PLAN REQUIR&fENTS <br />Indicate lot size, nano of streets, <br />-indicate location and width o.- <br />• alleys locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size r <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Humber of Stories <br />Basement <br />Signcd/By// II ad'_ <br />For l/" 0 <br />Owner Phone <br />ENE -FOR CITY USE ONLY <br />me Zone <br />Fire Zone <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />SprinY.lers Required <br />