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• <br />BUILDING <br />.-.• •_ a .T -� <br />PERMIT APPLICATION • <br />M <br />•' <br />Applicant To Complete This 5orm Yy <br />••' <br />If norr_ than one building is to <br />be contructed, submit a separate permit applica- <br />tion for each building. d separate permit will be issued for each building. <br />Oencr k1 f.r c _ "I <br />,, Building Address I <br />3Ldress i e Lot Block I , <br />City _Phone <br />Subdivision (Plat) <br />_. <br />Architect/Engineer. <br />• 2 �T �?� <br />•'. ^( <br />City _ Phone <br />Metes & Bounds (Unplatted) <br />:,•: <br />Ccmtractor <br />Sec. Twp. Rgc <br />_ <br />Address <br />, <br />i <br />City Phone <br />Building Usc <br />State License Number <br />Describe work to Be Done ' <br />• I <br />Szpiraticn Date <br />- SP.F.TCII PLOT 11L74] BELOW' <br />Use of Building <br />:J <br />❑ Addition ❑ Repair/Remo::el <br />' �'�, <br />• • , <br />r <br />• - Valuation of Construction $•-1, O0O.'— <br />�} <br />-. <br />- <br />PLOT PLAN REQUIRi:-1ENTS <br />�, <br />.� , •... _ <br />IAdicatc lot size, Wane of J�rnets, <br />•indicate location and widthof _ <br />alleys, locate proposed and all ' <br />. ;•'} <br />' ' <br />existing buildings, shoo distances <br />_ <br />to property lines, shoat distances <br />between buildings. <br />Lot size x — <br />• <br />• <br />Lot area Sq. Ft. <br />Size of Bldg. So. Ft. <br />•� <br />r• �'� <br />Number of Stories <br />Basement <br />Signed By <br />For <br />• <br />Owner Phone <br />DO NOT WRITE BELOW THIS LINF.-FOR CITY USE ONLY <br />/t <br />Date SCCeivcd '/ <br />Plan Chcc', :1uber <br />r., <br />2 °U Valuation vv11 . <br />remit FCC <br />Plan Chock 1'ce <br />Total Fee DUE! <br />Date T :sued <br />use. Zone <br />Fire Zone 3 <br />Occupancy Group <br />Type k Construction ,U - hj� _ <br />Occupant Load <br />Sprinklers 167Y (Ri E <br />AVPR,OV['D. FOR. BUiLDIUG PERMIT <br />