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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />--e than one building is to be contructed, submit a separate permit applica- <br />. Lion -each bU'ld-ng. A AeparateLpermit will be issued for each bu.Llkding. <br />Owner ( QV11Q✓ Saildin�g Address <br />Address ��, LotL�y Block Z <br />City Phone Suhdivisicn (Plat) <br />((j a G <br />' Architect/ gin 2t`"" <br />City L� Phone „� raa� Metes 4 Bounds (Unplatted) <br />Contractor •Ci Sec. Twp. Rge <br />Address <br />r <br />.t <br />.1: <br />• � I <br />;A <br />e <br />w , <br />( <br />•I <br />Phone G <br />State License Number <br />Expiration Date <br />SKETCH PLOT PLAN BELOW <br />...ter.) I <br />tot <br />®d <br />Building Use <br />_ Desc 'be 'ork to Be Do e <br />tJ(✓ U ✓ <br />j Use f building <br />I �ew ❑ Addition ❑ Repair/Remo;:el <br />1 Valuation of Construction $ <br />PLOT PLAN REQUIRE.%LENTS <br />Indicate lot size, name of streets, <br />indicate location and width of <br />�I alleys, locate proposed and all <br />existing nuildi.-,as, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size ��) x S <br />Lot area Sq. Ft. <br />Size of Bldg. 1 sc. Ft. <br />Number of Stories ( <br />Basement <br />Signed By <br />r For <br />Owner Phone <br />DO NOT InITE BELOU THIS LINE -FOR CITY USF. ONLY <br />Date Rcccivcd <br />Plan Check Number 7t% ; - Z6o`� <br />Valuation Colszo- <br />Permit Fee [. (0 C) <br />Plan Check Fee I D -7 <br />Total Fee Due ,34 Cj <br />Date Issued <br />Ur.e Zone <br />Fire Zone <br />Occupancy Group _. <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />