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BUILDING PERMZT APPLICATION /C�(� J� . . <br />Applicant To Complete This 3orm ��/�/,� � <br />/ <br />2f more th�n one building is to be cont:ucted, submit a separate permit appl?ca- <br />tion for each buildin�. A separate permit will be issued for each building. <br />Owner � � � Hvilding Address �-}- � � V��n �(.�, <br />Address � � � Lot � Block <br />City Phone Subdivision (Plat) � � � � <br />1lrchitect/Engineer � � � ' � �-� <br />City Phone Metes s Bounds (Unplatted) _ <br />Contractor � � _ Sec. 2Wy. Rge � <br />Address � ' � � " <br />City � � Phone Building Use - <br />State I•icense Number De�crihe Work to Be Done � ' <br />Expiration Date - ___ <br />SRETC'i PLOT PLAN BELOi4 <br />;� <br />. • . _!Cijj �-�i <br />C`� ' .._.. . \�� . <br />4 _� <br />I:� <br />I I <br />' i <br />.. .� . <br />Ose of Building <br />❑New C' Addition ❑ Repair/Remodel <br />Valuation o£ Construction $ <br />PIAT PLAN REQU7R&+fENTS . <br />Indicate lot size, name of streets, <br />indicate location a�d width of <br />alleys, lucate propo.•ed and all <br />existing builcings, show distances <br />to property lines, s:iow distances <br />between buildings. <br />Lot size ' � x - <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number of Storles <br />Basement <br />Signed 9y <br />For <br />Owrter Phcne � � " <br />GO \J'. F::I':: :3:,Oli _?(I5 i::ic <br />Date rec^i•�;ed �'� � �-' <br />n, ar. �Lc,:;: 2.u-�.;r �7`'a —� Lo tW� <br />1°d�llu;.10:1 _ <br />Pemi t Fee <br />Plan Check Fee <br />Total : ee Due <br />�e{J )Da[ Issued <br />` �" y� �, l�(X--l�_{-(-�+'ucc� =�11�`j/7 `� <br />� <br />U:.e 2one _ <br />Fire ZOne <br />Occuoancy Group _ <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />