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-- i <br />lOILDING PERMZT APPLICATION . � ' <br />Applicant To Complete This Form � '�.i <br />. /�� � . <br />If more than one 6uil�inq is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. <br />l <br />Ovner �,o.i :_ � %,_,. � , ___ Buildinq Address ,? � a O �,-��,{ <br />Mdress , 3 � a � � .0_ c �-= �, -,—L Lot � � �l-aZ.3 Block -> > '��a _ _ � �,7 <br />City ��-L.��'`.7` Phone Subdivision (Plat) � <br />Architect/Enqineer /,�..{i �ii.�.(',,�, �(i(_,1.�'C::; ; <br />City ��' �-�� �_�,{ Phone `� �r,.2 -.�D °(� Metes 6 Hounds (Unplatted) <br />Contractor i.( )� � ��i'e ,i(' i�ri, Sec. 7Rap. Rqe � <br />1lddress .3 4"O ( �� c: i� : <br />City �, < � �_ �� Phone a � c ,r0"(� Huildinq Use Ir'��� (`�;: 1C, -: � � <br />State License Nmaber Describe Work to Be Done �' <br />E:piration Dat:: <br />&10ETCIi PLOT PLA17 BELOfP <br />� <br />., y <br />Date �eceived � �7 �7 � <br />0 <br />��- ,� t �� � �: . V � / J "-' �. <br />IIse of Building � � `=-� � <br />�New ❑ Addition @-Aepair/Remo�el <br />� �SC�G � =-`- <br />Valuation of Construction $ <br />.. ?LOT PLAN REQUI?tE61ENT5 <br />Indicate lot size, name of street:.s, <br />indicate location and width of <br />� alleys, locate pr000sed a,^.d all <br />existing buildings, sho�a distances <br />. to property lines, show distanc�s <br />between buildings. <br />Plan Check :Iu.^..5er � " � <br />Valnation .G ,�'� C.� <br />Pemit Fee ��" � �� <br />Plan Check Fee <br />Total Fee Due ? 4 � v <br />� <br />Date Issued • - �'L/i �� <br />�T- <br />Lot size x <br />Lot area <br />Size of Bldg. <br />Nusber of Stories <br />Basement <br />Sq. Ft. <br />Sq. Ft. <br />�! Signed By %j�-tlta..(" , �!� , .�r-aJ <br />� <br />For <br />Owner Phone <br />U52 07SL'1 <br />U�e 2one <br />Fire 2onc <br />Occuoancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />b <br />