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� BUILDING PERh1IT APPLICATION ��� � 3 <br /> � Applicant To Complete This Form <br /> ��3/7'� <br /> If more than one bvilding is to be constructed, submit a separale permit <br /> application for each building. A separate permit wiil be iaeued Cor each <br /> buildi <br /> , � � o <br /> Owner 'J 1f � r � � ^, �Building Addrees ����3� �( p ,�Q }� <br /> Add^rees ��r��\ l�� l ��iJO 1.� Lo[ �� Block (�� � <br /> City~� �I'O,C��Q Phone� �- -��Subdiviaian (Plat) L•Y1 � �h�y�� �����{�.� <br /> Archite tc,/Engineer� <br /> City \� Phone Metes & Bounds (Unplatted) � <br /> ��^—� <br /> Contractoi� `� 4 � G��(Q Q<< 7 Sec._Twp,_Range_ - <br /> Jv r� <br /> AddreeR�'�'�-) C ,L)i�,�(1�(`C!ll� "��_� <br /> _�.�p.. � � �� <br /> _ Cit��1QhC� �v, Phnn��_ >�� Building Use <br /> State License Numher�Y,� '/ <br /> `-y����-��7,SDescribe Work to be Done <br /> � <br /> Expiration Dates� - I - � C� C c-� - <br /> SKETCH PLOT PLAN BLLON' �� <br /> � Use of Building <br /> . � �New L]Addi[ion ❑Repair/Remodel - � <br /> Valuation of Conntruction $�����(� �� <br /> PLOT PLAN REQUIREMENTS � <br /> Indicate lot size, name of etreets, <br /> indica[e location and width o[ alleye, <br /> locate proposed and all existing <br /> buildings, ahow ciistances to prop- <br /> er[y linea, show diatances between <br /> � , bvildings. <br /> Lot sizc x <br /> Lot arca Sq. Ft. <br /> Sizc of Bldg. Sq. Ft. <br /> Number of atoriea <br /> Basement <br /> �'� Signed By Date <br /> � - -- --- � �-Roz.- ti-- <br /> wne: Phone �` <br /> DO NOT WRITE BELOL4 THIS LINE - FOR CITY USE ONLY <br /> / � �Z-z <br /> � Date Reccived Cv' �� 7 � Use Zone <br /> Plan Check Number 7S Z7)^ Fire Zone <br /> Valuati������„ C� Occupancy Group j <br /> Permit Fee p p`� <br /> �iCr. Type of Conslruction y_- i.i <br /> Plan Check Fee �� e� Occupant Load T <br /> t <br /> Total Fce Due Q�- �� Sprinklers Re n�/ (1R Rliu DING PERMIT <br /> I. `941��€9-F <br /> Date Ieeved � �j 1 . _ � i� �: , r <br /> �3�C I / � � i `� RY <br />