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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />/��� =, <br />/s/s <br />If more than one building is fo be constructed, submit a aeparate permit <br />applieation for each building, A separate permit witl be issued for each <br />buildig <br />/ n � <br />Owp'�er `� -{}�, � �Qi �i LM_!11Q_l Suilding Addresst e�Gio �� <br />Address a'� � Lot�_Slock _� <br />City�11C?.�"�'�_, Pionr�^�� Subdivision (Plat) Q�� <br />4rchi[ect/Engineer <br />City�_Phone Me[es & Bounds (Unpla[[ed) <br />Addree <br />Ci <br />Se c. 1 wp. _Range <br />Use <br />State License Numbep�,�-(��-���i-c[QDeseribe Work to be Done <br />^ o n <br />ExpirationDate c�-�'1el �A�L�.41(1)r> ��i0M2 Oi � <br />SKETCH PLOT PLAN BGLOW <br />DO NOT <br />Date Reccived <br />Plan Check Number <br />Usc o: Building � <br />,� New � Addition �Repair/Remodel <br />Valuation of Constru�lion $ ��'y- /�, p� <br />PLOT PLAN REQUIREMENTS <br />In6icate lot size, name oC streets, <br />indicalc location and wid[h of alleys, <br />locate proposed an3 all c:isting � <br />buildinga, show distances to prop- <br />erty linea, show dislancr.s between <br />buildings. <br />Lot eize <br />Lot area <br />Size of Bldg._ <br />Number ot stories <br />Basement <br />x <br />Sq. Ft. <br />Sq. Ft. <br />�gignrd Date <br />�For �-� . (� ,. a r./� � <br />Owner Phone ,— -�,"�� / <br />NE - FOR CITY USr ONLY <br />S J Y Use Zonc <br />Firc Zonc <br />Valuation �� �iy�- <br />� <br />`! �� <br />Pcrmit Fcc 2 d ,' <br />Occupanc�' Group <br />Ty�.� of Go� struc <br />Plan Check Fee _ Occupa�.� '.oad_ <br />�7 U'U <br />Total Fee Due L"��" _ Sprinkler� Requircd <br />Datc Issued <br />