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, EUiLDINC PERMIT APPLICATION ' � / C� C�`j� <br /> . . � �� Applieant To Completc Thia Form � (f � <br /> Ilmore khan one buildinq ie to be eonetzueted, eubmit a eeparate permit //� <br /> application for each building, A eeparate permit will be ieeued for each <br /> building. <br /> Ownar� � � .��. S Building Addreae �7I� S�iQR� A�C � <br /> . Addreu � 6'� Lot U��Z Bloek � � " <br /> ��7�_Pbone��� Subdi �ion (Plat) �V�6R� /'�C�QS yp4�• /'iy ' <br /> Arehitect/Engiacer � ��(�'� - � � �, �� � , <br /> —-� <br /> City��gnone '7IZ Metee & Bounda (Unpla[ted) . . � <br /> Contraetor � � <br /> See. Twp.__gange <br /> Addre��?j; ( I S QR� �Yt <br /> � City CVCR<.� . Phone ��%�� Building Uae �d nc{ <br /> State.Lice¢�e Number � Deeer' Work to be Doue <br /> Fspiration Date ��(J � � C'� ( <br /> SKETCH PLOT PLAN BLLOW � <br /> � � 'LJ�rof Building�S� I pMG r <br /> � �. �. . . IINew Qqddition �epair/Remodel <br /> Valuatioa of Conetruction $ I � v o � <br /> � PLOT PLAN REQUIREMENTS <br /> . � � Indiute lot size, name of streeta, <br /> ' . � � indicate location and width of alleys, <br /> . . locate proposed and all exieting <br /> buildiags, show dis Wnces to prop- <br /> .. erty Hnes, show distances between <br /> buildings. <br /> Lot dze x <br /> Lot area Sq. Ft, � <br /> Size o[ Bldg. Sq. Ft. <br /> � Numbcr of storiee � <br /> � � � Basement � � <br /> Signed B Date <br /> For /� ` <br /> ' ner hone i (////I,G 1 <br /> DO NOT WRI/TE BELOW THIS LiNE - FOR CITY USE ONLY �2s^�' S �j � <br /> J / CI�', <br /> Date Received .�' `�' ' l� Uee Zone Q_ S 5 S_ � , 1 , � <br /> Plan Check Number 1 b— � 43 Fire Zone � <br /> ' wMANiw <br /> o� <br /> Valuation 13 L O t� —' Occupancy Group t <br /> P�rmit Fee � (,q- p J Type of Conetruc[ion � � <br /> Plan Check Fee � 3 2:. o O Occupant Load ��T�� ��� �����r[TT <br /> � <br /> Total Fee Due 9 (� . c�o Sprinklere Reqvired��l'r',)' �I) ! fl^ f�uiLGING PFRMIT <br /> � Date Iseued - � . . n�„ � <br />