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BUILDING PERMIT APPLICATION /8 / /�/�•� <br />Applicant To Complete This Form <br />If more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. <br />Owner / /�L .i q-��C/<�f�.r ,. Fuilding Address <br />Address a� 7 d 3 u � `— �s f Lot j / x. (' t d- Block ` d <br />City %.emu Phone o2>aSubdivision (Plat) w. _ <br />Architect/Engineer l�..t'�1. _.•� <br />City Phone Metes 6 Eounds (Unplat ted) _ <br />Contractor Scc.Twp. F.ge <br />Address <br />City <br />State License Number <br />i Expiration Date <br />Phone <br />SKETCH PLOT PLAN BEL014 <br />yGf Ft <br />a <br />'f <br />DO NO: WRIT <br />Date received <br />Plan Chec:: ".cumber <br />Valuation <br />Permit Fee .__s=L=.— <br />Plan Check Fec <br />Total Fee Due <br />Date Issu^d <br />Building Use <br />Describe Work to Be Done l �Q <br />vet/%1 <br />Use of Building <br />New ❑ Addition ❑ Repair;Remodel <br />Valuation of Construction $ aOO'`_ <br />f1 PLOT PLAN REQUIREMENTS <br />L Indicate lot size, nam!: of streets, <br />L indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg. So. Ft. <br />�-r% /✓� Number of Stories <br />Bement _ <br />Sig cd By ,2 A '4 <br />For - //' Ct <br />' Owner Phone ��_ <br />�THIS LINE -FOR CITY USE <br />U_,e Zone " <br />Fire Zone <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />�✓ ��Nu� <br />