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/ / <br /> � �� � � <br /> BUILDING PERMIT APPI.ICATZON / / � <br /> . Applicant To Complete This Form i /• 7� <br /> If more than one building is to be constructed, submit a separate Permit ap- <br /> plication for each building. A separate permit will be issued for each build- � <br /> ing. <br /> ` � . <br /> Owncr`?/- `Jj•y /SI/��L/V � ; ,� � Auilding naar�ss '�i�lO3 S�-/,r�j� <br /> Address !/pp 3 • $��r/� zot 31k._� Sec., <br /> City,�Lef��f Phone_ Twp. Rgc. � <br /> Architect • - Subdivision (Plat) <br /> City Phone MeCes & IIounds (Unplatted) <br /> Contractor.,57�fh' /�aY� �/YNk:r_iyenl � �J�17` af�N b7� n.��h <br /> Address /3d1 �1�dide/✓ - L/" 3 9 u ri= /dLcv .l ' <br /> City��.�pa'f Phone IIuilding Use <br /> � � State License Number:`��j ^0/= 9G,(o1 ' Describe 19orY, to De Done �eiYttiY fL••NY�}1t({ <br /> Expiration Datc =i - i7/ — 7S' l.d,.,�.�� /=ro,v� ur:Tc%�' y�,vd J.�, c7� � �_ <br /> N <br /> �Pro,�s�_.r1,�d R e Si[�� t /LYc.t /3��•�p <br /> - Use of 13vildiny <br /> , n S, w p �, ` '._New .. Addition Repair/Renodel <br /> Q GotJG �.a.�� r� <br /> Valuation of Constructi,on $ !i0'�"� <br /> ��"'�� ' p� ���� � PIAT PLI�N <br /> �"�/�� � � 1 _ Indicate ].ot size, name of strects, <br /> � ` "��� indicatc location and �vidth of <br /> � . � alleys, locate proposed and all <br /> � - � existing buildings, show distances <br /> � to property lines, show �3istances <br /> between buil.dings. <br /> . �• S �°TaF va��� fL. Lot ��7� X <br /> � Lot arca S.P. <br /> ^-� �� � {.�, �,�.� - Size of Bldg. S.E. ; I <br /> i �` Vt-�+^� l. � Number oE Stories <br /> llasement � - <br /> Use Zone <br /> � Signed IIY LL i��,;.., �)C L�.v.�� �_.� � , <br /> tor <br /> owner I <br /> DO NOT WRITi� DIiI,OtJ TllIS LIN�-I'OR CITY USE ONLY <br /> i <br /> Date Feceived Fire Zone ' <br /> Plan Check number. � Type of Con�truction . <br /> Valuation � Occupancy Group <br /> .Permit I'ee Occupant Load <br /> Plan Check Fce Sprinklcrs Reyui.red <br /> Total I'ec Duc 1 �f � <br /> Permit tdum]>rr A{� [.���� �] <br /> natc Issuca (/// ��� ! �� � <br /> V . <br /> APPROV[D FOR �UILDIfJG PCRMIT <br /> �.,�,. <br />