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.. . . . <br />; � DOILDING PERMZT APPLICATION . . ' ;;,y <br />• . . 1lpplicant To Complete This ^orm i' ;i �'� . 'F � <br />• . � <br />• I! more than one buildinq is to be contructed, submit a separate permit applica-'' "- <br />.. tion for each buildin�. .1 separate permit will bc issued for each buildinq. <br />' ' Ovner ����Ai� � � �-�-�N / %E Huildin Address � � . <br />4 , '�lr% i �cc°KP�C: <br />� � <br />_ llddress •7irl ,f(uc'K C'/� Lot /U, 1 / I � Hlock / �.S � <br />. City /��r.l'r f7 _ Phone -�J `I "�1 %G7 Subdivision (Plat) (?/�'fl/'�,'/r r✓ />�ir� . <br />' • Architect/Enqineer yT ��n�`/ (�/J�d/.fl � � � <br />'"� City �dPC'C� PhoneSS,j� %%/�' Hetes Z nounds (Onplatted) <br />"f <br />:, Coatractor ��lE�' /-C�C'/.'c'`/ Sec. Twp. Rqe � <br />� ' ' ]ld8ress %J �a.2 - �CI(/P�' il ��? c . . . . <br />,L � <br />.'' City CUP�CPP Phone Building Use ��/5/c�f/-���' •;=�' <br />' �;� � Stnte.Li.cense Na�aber �,�,�-p/- S,�%;�eL Describe Work to Be Done .5���_ �?/qN ���'�'� <br />, . . . ''i Lzpiration DatB % - 1 - %� � .F/h�C! l>lC� _ � <br />SRETCH PLOT YLAN HELOIP� <br />�`' t' :. :,O/A,`� . . .. . <br />� <br />_. ..._y . <br />� . <br />� <br />:.. • <br />Date �eceived <br />� Dse of Building ;Ai'S /C�e/'� �' � ' <br />�Ner+ � Addition ❑ Repair/Remo;:el <br />• o.� <br />Valuation of Construction S .�C� �'E•� � <br />PLOT PLA2d REQUZRE�tENTS , <br />Indicate lot size, name of streets, <br />� �indica:c location an� width of <br />• � alleys, locate proposed a:d all - <br />existing buildiags, sho•.a distances � <br />-�. to proper:^ �ines, show distances <br />betNeen buildings. <br />bot size '� � .�'�%x /y�$l - <br />� Lot area Sq. Ft. <br />� Size of Bldg. ��� C Sq. Ft. <br />Number oE Staries <br />Basement /vG��JF_ � <br />�- <br />Signed By ��:.� �� - "t•�.� :� <br />' Plan Check ]:ur..Ser �S ' Z�C� � <br />Valuation %�0 �C� �L� <br />Pemit Fee �2, �� <br />. /I �� <br />Plan Check Fee y��'� _ <br />. , � Total Fee Due ( �J U ' <br />• i i <br />Daie Issued ��/7 7 � <br />�� ��,.�,(,_� �._�' , . <br />� I <br />For <br />Owner Phonc �t� - ,;��C' 7 • <br />Bcls . %? � y' 77G / . <br />'c-i0Z Ci'fY USE Oi7L7 <br />Uce-2one � � <br />- � <br />Fire 2one <br />Occunancy Grou� _ <br />Type of Construction <br />Occupant Lo�d <br />Sprinklezs Required <br />