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BUILDING PERMIT APPI.ICATION <br /> / �i �� <br /> , Applicant To Complete Thia Form <br /> . �/c�� <br /> If more than one building is to be consLrucCed, submit a separate permit ap- <br /> plication for each building. A separate permit will be issued for each build- � <br /> ing. <br /> Owner--�f�`L� �� Du.ilding Address �(�'U �S -� W�'I,(�L(-f�7i. <br /> s�,s. _ 3 <br /> Tddreas_ . /�� . %/7, �, /n Lot IIlk. � '�' �Sec. � <br /> City Phone Twp. Rge. � <br /> Architect • � Subdivision (Plat)�����1�/,�<; /7 � . <br /> City_ _ Phone Metes & IIounds (Unplatted) <br /> Contractor a� i �( � � <br /> Address����(J /.'�'(� i{ c2C�- <br /> c <br /> City�'���-�1�- Phone�U�/ � Building Use <br /> State License Number' [1 �� ��_10 J� De�c ibe kork t IIe Done <br /> Gapf.ration bate /�1l_Q_C- �(�, l�7G0 � - � ���,..�_ . <br /> � <br /> - Use of Building <br /> . '�New _ Addition Repair/Renodel � <br /> . Valuation of Construction �$ �V`�'��� <br /> � � � PLOT PLAN <br /> ' Indicate lot size, name of streets, <br /> - indicate locatior. and width oE <br /> � � allcys, locate proposed and zll <br /> - � � � existiny buildings, show distances <br /> � � to property lines, show distances <br /> between buildings. <br /> . Lot sia.e x � <br /> � Lot area g,r, ; i <br /> Size of 131ay. g,g, i <br /> Nurnber of Stories <br /> . Basement • <br /> Use Zone� — <br /> � � Siqned Dy <br /> ror � <br /> Owner I <br /> b0 NOT WRI7'Si IlE1AW THIS LItdl.FOR C7TY US7: ONLY <br /> i-- <br /> Uate Received - � Fire Zone <br /> Plan Check NumUer.. Type of Construction <br /> Valuation ��'� . �y . Occupancy Grouy_ � <br /> .Permit fice ��. � Occupant Load <br /> Plan Check Pce Sprinkle�s Required <br /> Total Pee Due �� � <br /> Pcrmit taumbr_r � <br /> Datc lssucd � � <br /> ��"` �2C`y�'��� m'._� �GLh� <br /> �CC�L ��� ���� ��y, �.�� /��, APpROVEb fOR f3UILDING PCRMIT <br /> L <br /> � Dile__ „ <br />