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BUILDING PERMIT APPLICATION �/ <br /> �W, � Applicant To Complete This Forrr, <br /> � / ��' / <br /> � If more than one building is to be constructed, submit a separate permit <br /> • • application for each building. A separate permit will Ue issued for each <br /> building. <br /> �� `� � . <br /> owner � fl ,�/)Nf✓I RA� s :��-" �� � <br /> Buildin Address �;',-'S� � � �_ �•� �� <br /> � <br /> i <br /> Address,37iS Jh�SC'j' ��1"'�'- Lot /�i Block <br /> City_T r�t2E.l7 �1��Phone Subdivision (Plat)t�.;�t�r-r•'P �i�i�i'�d/ <br /> Archi[ect/Engineer <br /> City Phone_ Metes & Bounds (Unpla[ted) <br /> Con[ractor R S �C, l`^MS"t"-ZY?= Sec._Twp._Aange <br /> Address�?(�). (3v 2l?7 <br /> n � <br /> City ��7a l7.f.� Phonc �L • - � Building Use /� P.i.�C�,t}�r4 L _ <br /> � <br /> State License Number2�3-��l- /D:S? Describe Work to 6e Done (;>�„•, �� <br /> . Expiration Date — <br /> SKETCH PLOT PLAN BGLOW � <br /> Uee ot Building _ <br /> .L7 New �[7 Addition ❑� Repair/Remodel <br /> Valuation of Cons[ruction 5 �S�Q � <br /> PLOT PLAN REQUIREMENTS <br /> Indicate lot size, name o[ streets, <br /> iadieatc location and width of alleys, <br /> � locate proposed and all existing <br /> � buildings, show dis[ances to prop- <br /> � er[y lines, show distances bet�veen <br /> buildings. <br /> Lol aize 'J.�� x 1��4��% <br /> ' • Lot area Sq. 'r t. <br /> -� <br /> ( 3r�,q�_ <br /> - ��z� or Bias.�t q3 sy. Fc. <br /> Numbcr o: stories <br /> Baecment _� <br /> / - <br /> Signed By,���i(ili,�•fi�: Date Jii;�.r <br /> • � / � �. .�% ,f r.-`y�) <br /> � For ,1�:..J ; i ���: . ,��; <br /> ' Owner Phone . `•;.: �/!"=!�� <br /> re <br /> DO NOT WffiTE RLLO\1' THIS LINE - FOR CITY USE OA'LY <br /> Date Reccived �S 75J Use Zone <br /> Plan Check Numbcr 75"' Z�'��]. Fire Zone � <br /> Valuation Occupancy Group <br /> Permi[ Fee 1'ypc o: Conslruction <br /> Plan Check Fee Occupant Load <br /> Total ;ee Due Sprinklcrs Reyuired <br /> Datc Issucd . <br />