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-•. ,:' <br />_ <br />BOILDING PERMIT APPLICATION '• •;}•�� <br />Applicant To Complete This Form q <br />j/1< <br />.. : <br />If more than one building is to be contructed, submit a se arate <br />tion for each building. A separate permit will be issued for eachebuilding. ss7 <br />�/ <br />Amer <br />7� <br />Building Address -30C2 W3�-rµca ; <br />. <br />Address <br />L00tZ-7- Block <br />CLty Phone_._ <br />Subdivision (Plat)_ <br />_ <br />.-_'� <br />Architect/Engineer <br />_ '4! <br />city Phone <br />Metes i Bounds (Unplatted) <br />- , <br />Contractor <br />sec. Twp. Rge ' <br />Address <br />sty Phone <br />Building Use C <br />4t <br />• y, <br />State License Number <br />Describe Work to Be Done <br />I <br />Expiration Date <br />�1l <br />SKETCH PLOT PLAN BELOW' <br />_ <br />_ _.. <br />Dae of Building <br />'t3mev <br />❑ Addition Q-Xepair/Remonel <br />- <br />Valuation of Construction Cod <br />. <br />PLOT PLAN REQUIREMENTS <br />• <br />•a" <br />' <br />Indicate lot size, name of streets, <br />'indicate <br />location and width of <br />alleys, locate proposed and all <br />'•:•• <br />existin buildings, shoo distances <br />. } <br />to property lines, show distances <br />between buildings. <br />FR710 <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldq. So. Ft. <br />Number of Stories <br />Basement <br />Signmd By <br />For <br />Owner Phone <br />1�:ITL BELOW 711I5 LINE - <br />Date �*ceivcd C' Z -7 )• ^ <br />P1an.Chcck Number <br />Valuation _2.C29D•�- <br />Permit Fee %— <br />Plan Check Fee <br />Total Fee Due <br />i <br />Date Issued <br />ITY USE ONLY <br />Ute Zone ��- <br />Fire Zone - <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />