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/•�y" <br />BUILDING PERMIT APPLICATION T <br />4plieant To Complete This form <br />Jf rore than one building is to be contracted, submit a separate permit applica- <br />tion for each building.A separate permit will be issued for each building. <br />i <br />,1 <br />Nmer �1��,�. oh 3., sr <br />Building Address 3 3,2 ( V•Y{ «,( , <br />1I/1 <br />Udress CLI'Abti 01 _ <br />Lot i Z Block <br />City lazsi � L Phone <br />Subdivision (Plat) <br />_ <br />AXChiteet/Engineer <br />, <br />( <br />city Phone <br />Mete:; L Bounds (Unplattcd) <br />Caatractor ba,,': %d,..,or,i <br />Sec. _ Egu .. <br />,City jy�YY11 Phone 35:2'Q413 <br />Building Use <br />• <br />State. License N=nber _ <br />Describe Work, to Be Done iN,t,j( Tlrf. <br />. �1 <br />Brpirat-ion Dath <br />SKETCH. PLOT Pli27 BrLOW' <br />I <br />` ;AI�K�o <br />�j II <br />cc �w�{r �. e <br />Use of Building <br />` <br />yVy <br />au - 0'•+w�p/ <br />�_ I•lew ❑Addition RR In <br />I <br />/ <br />11 NTV .3$ i vk O.A.•' <br />_.goo��vs <br />Valuation of Construction $ ." <br />{(W? \' � . PLOT PLAN RrQUI'M-ENTS <br />Indicate lot size, name of streets, <br />'indicate loc tion and width 04 <br />alleys,•locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />a between buildings. <br />Lot size x _ <br />Lot area Sq.- Ft. <br />Size of IIldg. _ So. Ft. <br />N=b:!r of Stone:; <br />Bascnent--`----- - <br />Signed IIy �- <br />ror <br />u ncr Phone <br />DO NOT WnTTT: BELOW TITS TJNr,-TOR ("M Ur,-, ONLY _ <br />Date S_,ceived U-e-7,one _ <br />Plan Choc% `:ur..ber Fire Zone <br />Valuation "- - Occupancy G'.Qup <br />Pewit Fee -_ _ - Type of Constri:c, ion <br />Plan Check Fee r _ Occupant Load <br />Total Fee Due Sprin%lcr. R•:quirrd <br />i .cc Issued ,.�_ _-- <br />