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� ' BUZLDID'G PERMIT APPLICATION /'�����' <br />" �. Applicanc To Complete This ?orm /.Z �/ <br />Zf more than one building is to be contructed, submit a separate pennit a,�,% �;Sa- ,y <br />tion for each building. .1 separate permit will be issued for each building. <br />� p�,.�er � y�__, �,e,�r..� �3✓..^ Building Address �$�O,S '/li�r���..` <br />, Address � �, ,�'.----i i� / 7 S �t�_ Slock � <br />,p �7 r �, <br />. City fw, '-/�-� �, Phone,/ 7� C:-.S Su!�division (Plat) +�-���.� !:_�_�r:' <br />� <br />� <br />� <br />. <br />w. • <br />Azchitect/Engineer <br />City Phone <br />Contractor ( �� � rh4..� �- ' <br />Addiess Q—!� yY-?- �J/� Q�.-?r�i-�-- <br />City Phone <br />State Lir.ense Number <br />Expiration Date <br />� S� RE�TC�H .P� L�O� I.AN B�L-�O1Q ��/� <br />--- i{�-----_ _ . <br />R <br />I D � �p � !, . <br />I <br />I. � <br />, ," , � . <br />DO Iv'0': <br />Metes 6 Bounds (UnplattedJ <br />Sec. 'h�p. Rge <br />Building Use <br />Describe Work to IIe Done <br />Use of Building � <br />�?lew ❑ Addition ❑ Reeair/Remodel <br />S' <br />Valuation of Construction S �%✓�� V <br />pLOT pLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width o: <br />alleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />.h f� Lot size (D D x �(� � <br />\�� Lot area '7 �'� v Sq. Ft. <br />Size of Bldg. �.D Y ��J i Sq. Ft. ��7un <br />Number of Stories <br />Basement � ..0 7 . - <br />Sig::ed 9y �( l'r- l- �( J�� -"% . <br />roz � �r�s <br />� Owner Phone ___ <br />Datr .,eceived / 7 � 2 - 7 � <br />`.vZS LI:�IE-"rU:'. C1 <br />U�e �one <br />P1a� � �ccl: ::cm::er �'T `� / C� <br />9a'_uatio; ������� <br />Pemit Fee <br />� <br />P1an Ched: Fee <br />5� °= <br />f �� _ <br />Total Fee Due <br />Datc Issued _�� ! �! r� <br />i �/� /� <br />/`� ; Y <br />/i /'' `_.{ ��..�!<�G.'l�r' " .. <br />Fire Zor.e <br />Oi1LY <br />L�� - ��. � <br />� ' <br />Occuoanc7 Group _ <br />Type of Construction <br />Occu[�ant Load <br />Sprinklers Required <br />. _ �.. � i..,_ i i <br />� .�. ��.�.�i �]U��.L7��`�'.. I���-i.�,. <br />