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BUILDING PERMIT APPLICATION • <br /> Applicant To Complete This Form /�a /J <br /> If more than one building is fo be conatructed, submit a separate permit . ,�/�7�5 <br /> application for each building. A separate permit will be issued for each <br /> building. <br /> Owne - �' M Building Address I;y��j ��p`���e�� <br /> Addreea � . �� -� Lot��_glock��[� <br /> City (�Phon �(�� Subdivieion Plat �'r• �(� <br /> ( � rcc�� �{- "'C �l'��.7J <br /> � <br /> Architect/Engineer_ � ��L. 9 . <br /> City �\ phone �� Metes & Bounds (Unplatted) <br /> Contract�iT �'�1p"� . �"�/ (�Y � 1} � Sec. Twp. Range <br /> Addrese�y-y� 7�� (��('Il� C�1'$� � A�L�— — <br /> � Ci[�'���Phon��y���� Bvildina Uee <br /> State Licenae Numbe���--Q�-���Describe Work to be Done <br /> Expiration Date �i-c�j--�� 4. . �� �`,�^ ^\ <br /> �li�dJ 1 <br /> SKETCH PLOT PLAN BELO�V - r � <br /> Use of Building•���a A�Ll [ _ <br /> II New []Addi[ion QRepair/Remodcl <br /> Valuation of Conetruction $�a�-� �V O � <br /> PLOT PLAN REQUIREMENTS <br /> Indicate lot size, name of streets, <br /> indicatc location and width of alleys, <br /> loeate proposed and all existing � <br /> buildinga, show distances to prop- <br /> erty lines, show distances between <br /> buildings. <br /> Lot size x <br /> Lot area__ Sq. Ft. <br /> Size of Bldg, Sq. Ft. <br /> Number of storiea <br /> Basement <br /> Si Ced-�By—. Date . <br /> For_ _ ..\ .-�. Y��l f �n tiJ <br /> Owner Phone <br /> DO NOT WRITE BELOIN THIS LINE - FOR CITY USE ONLY <br /> � <br /> � Date Reccived � Use Zone <br /> Plan Check Num6er Fire 7one <br /> ' Valuation I Z� � Occupancy Group <br /> Permit Fee � <br /> �3� �'� Type oC Construction <br /> Plan Check Fee Occupant Load <br /> (,9(> <br /> Total Fec Duc � �• Sptinklers Required <br /> � Date feeucd <br />