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SUILDINC PERMIT APPLICATION <br />• Appllcan[ To Complete Thia Form <br />/�'�/�� <br />/ <br />If more than one building [e to be conetructed, submit a eeparate permit .3`.3�,� <br />�pplication for each building. A eeparate permit will be iaaued For each <br />building. <br />I/I/� F � <br />Owaer i-tc.i r;1 � t' !.�/R r" � i�f�1` Building Addrees %�•0 !�,� 1�^! (: /'.1'�,+ jj <br />\ . , <br />Addre�n CI � � ,�v Ali ( /,; .. " �� Lo! 1�Bloek � • <br />Cih 1- 1/p N/.Sj- +� Phone .�- �, S� 2 SS � Subdivi�ion Plat � 1�-� '^ <br />( ) ��rt�o.s^,.'..� a J,_[.r��; � �,^ <br />Are�.ttect/Engiaee <br />Cil7 Phane Metee k Bounds (Unplatted) . <br />Contraekor � See. Twp._Range_ <br />Addres� <br />City Phone` Building Uae� �: i v� :� P <br />� <br />State.Lieeaee Number Describe Work to be Done bi. il r! � A"` !,� <br />Expitation Date � <br />SKETCH PLOT PLAN BLLOW <br />ki�o�1 ��;,�:�,� A vr, <br />- ri: I . _ ---f • <br />i2 <br />� <br />ll�j, <br />�� � } <br />r 1` h(��9 f E� f� . <br />' �. <br />t L S � —k <br />•o.� or s,aia�� =, �,-� -'n <br />IINew �Addition �f_jRepair/Remodel <br />Valuation of Conetruction $ f 0 4 � <br />PLOT PLAN REQUIREMENTS <br />Indieate lot size, name o[ streets, <br />indieate loeation and width of alleys, <br />� locate proposed and all exisling <br />Miildinga, show distances ta prop- <br />erty liaea, show distances between <br />buildings. <br />. I ^� , <br />Lot dae�_x G i � <br />Lo[area ��� 6S � � Sq. Ft, <br />Sice of Bldg. �{- /) Sq. Ft. <br />Number of storiee � <br />' Baeement^/I�A � <br />I � Signed By Date <br />� �� n �^ / �� � .--/' <br />'�- For` ') ,f . /� � ' l t � i�l.-� �c'_ � ' <br />'r � � �Owne� ' Phone_ <br />DO NOT WRITE SELOW THIS LINE - FOR CITY USE ONLY <br />Date Reeeived Uee Zone <br />Plan Cheek Number <br />Fire <br />Yalwtion Occupancy Group <br />Permit Fee <br />Plan Check <br />Type of Conatruction <br />Occupant <br />Total'c'ec Due � Sprinklera Required <br />Aate.Iesued <br />� <br />!/ ! J/ . <br /># °a. <br />