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' � ; lOILDING PERM2T APPLICATION � . ��� •� <br />: � �pplicant To Complete This ?orm ..�'s <br />, •� IL oore lhan ane building is to be contructed, submit a separate permit applica- <br />. tlOn for each buildinq. A separate oermit will hc issued for each buildinq. <br />� ��dmer r�['�,i �'C�U�A)/>1.�T CI'�U�t't'� Huildinq•.Address ' . <br />. ,4, 3ddreas Lot _ Block ' <br />City F 11�f i; Phone Subdivision (Plat) •- <br />. - lrchitect/Enqineer L� {�/�iiZIC K M 17CNE�� �_ ' <br />_ _ ':i City �'= i'�I�)� Phone 7-}�-��f�"'� Metes L Sounds (Unplatted) _: � <br />. :,' Contractor O Ll.� Al L"'1"l .�'t �- 0 3�7 � Sec. Tup. Rge _ <br />. � idLress � � � <br />_ ; ' <br />; City Phone Buildinq Use C la U f2 c I-� "ti �..,; <br />tii . . <br />�) Etate,License Number Describe Work to Be Dor.e �UIV1� � <br />� • . .I L=piration Dat� � /� � P�(.� �y L 1� (-, <br />��' ' � � SRETCti PLOT PLAN BELOfQ' � • <br />' � j Dse of Building �NINecH � <br />� �' . ' : . . . . . ' �New ❑ Addition ❑ Repair/xemofie?_ <br />.. _ . . <br />' • • Valuation of Construction S'"� O�� CY�O � _ <br />.�,. _ � � , � � � � ^ . PLOT PLAN REQUI?2EMENTS , . <br />,�, , . . . . � � . . <br />� . . . , . , , . . . <br />• _ - Iadicate lot size, name of streets, <br />.' ' � � � � � - � � . 'indicate location and width o� . <br />. 3 � ' -_ � � alleys, locate nr000sed and all � - <br />. • .�� - , � � �. � , . � . existing buildinys, show distances <br />_ •- v .': to property lines, show distances <br />'_ ' • , ' - betaeen buildings. <br />, ' . - Lot size x <br />. • ` <br />..-- ' � Lot area Sq. Ft. <br />�. . - � Size of Bldg. Sq. Ft. : <br />•; • Number af Stories <br />. .: i. . . Basement _ <br />:.. 7{- �) �� // <br />`� �. �. � Signed By �� _ ��Pl�;� 1�1.1+-� LT[9�l% <br />. ; � <br />• � - �For <br />� � - � . Owner Phone <br />� PO NOT t':2ITL HSLO[�i THSS LI:7E-FOR CITY USc OC7L'f <br />. Date F:eceived 1.7�-( 5" Ace 2one <br />.r�.� <br />' Plan Chec� :Ic...ocr `� S'j ��`� Fire Zone ' <br />Valuation Oecuoancy Group <br />Pemit Fee 'lype of Construction <br />. Plan Check Fee Occupant Load <br />ibtal Fee Due _ Sprinklers Required <br />Date Issued �I � � ., . . - ' <br />G <br />