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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more than one building is Eo be constructed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />building. <br />Otvne 1 1 i Building Address-.���(? <br />Address ''1-r-1( LoOl V-ZU1 Block f� n <br />City C K cep Phon r n Subdivision (Plat) L U-P t. a Q- u!w • , 1 <br />Architect/Engineer <br />City \ Phone_ Metes & Bounds (Unplatted) <br />Contractor L_t-Lltr ��- OriQ i )Sec. Twp._Range <br />State License Nu/Imber�D?-Q L-//.�2,SDescribe Work to be Done � ' C (�t��l"1'�� <br />Expiration Date <br />SKETCH PLOT PLAN BELOW <br />Use of Building' <br />L7 New ❑ Addition [Repair/Remodel <br />Valuation of Construction 5 <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of alleys, <br />locate proposed and all existing <br />buildings, 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 stories <br />Basement <br />r ned By Date <br />For "NA nn <br />Owner Phone <br />DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY <br />Date Received Z `5--7S^ Use Zone <br />Plan Check Number <br />Valuation Ilp Permit Fee Fee / 7 <br />Plan Check Fee <br />Total Fee Du <br />Date Issued <br />Fire Zone <br />Occupancy Group <br />Type of Constructio <br />Occupant Load <br />Sprinklers Required <br />