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DUILDING PERMI7' APPLICATION <br />Applicant To Complete This Form <br />/��� � <br />3�a��7s <br />,. If more than one building is to be constructed, suUmit a separate permit ap- . <br />plication for each building. A separate petmiL will be issued tor uach build- <br />ing. <br />�� �-- ' <br />Owner� iL�°C � �',r����,�� � �•�' �- IIvildinq nddress - �'�_�� �.'�./� �l — <br />Address % `.'� � • % ) �� � � Lot�-j__ IIlk. � Sec.__ <br />City �/.i`� %= / / Phone;�.��-_ ��� j 't'wp. Rge. � <br />�,�� f � „i> <br />F�rchitect `;l'��a�� _� �ubdivision (Plat)..'`.'.f �'?i��` � =������ : � .�-� <br />. <br />City <br />Yhonc <br />Contractor =�.��_��a— �� <br />Address <br />Ci <br />Phone <br />State License Number" - � <br />Expization Date <br />� <br />�. c . , , ; �Uv <br />bletes & IIounds (Unplatted', <br />Suilding Use `��•,;��. j.,,. �.- •..i � <br />Describe iJorY, to IIe Uonc <br />Use of lluilding <br />i <br />L New .-Addition Repa�/Fencdel <br />i <br />ValuaCion of Constructi,on $ � ��! < < � � <br />PLOT PLI�N <br />Indicate lot size, name of streets, <br />. indicatc l.oaition and �.idth of <br />. � allcys, loc���te proposed ai��d all <br />.� existin9 buildin9s, show distances <br />� - to property ].ines, show �3ist�nces <br />between buildings. <br />Lot size � ' x =/� � . <br />T.ot arca --- . �.�, S.F. . <br />Size ot F31d9. � �-'r ��'�'U — S•t�• I <br />Nunil�er oE Storics � � <br />Dasement ��� � �r��c�_ <br />,, <br />Usc 2aie � ts' ,r-R_<' <br />Signed IIy-'� - _ <br />For �i 'jq' / ;' v i, 1 .� : <br />Owne:. <br />DO NOT WRI1'li UliLOW TllIS LINE-F012 CiTY USE Ot����Y <br />D�te Reccived _ Firc r".onc 3 <br />Plan Check Numl:er � '7� -(>9 _ ZYPc of Conatructi.on_ :1' - til <br />Valuation 3`j� �*+w .�-o Occupa�cy Group 1 <br />PcrmiC Pec i� 4 0 o OccupanL Load — <br />' Plm� Check Pee 1'1.i,w Sprinklers Siequirc9 � _ <br />7'otal tce uuc z 3� o� CI I Y OF E`iLREiT <br />APPRCVED FOR DUILUING PERNiII' <br />Yermit NumUrr ' .� / � <br />uato Issucd � � Date�L���_f3y. ��� � ._, <br />APPRQVED FOR DUILDI�JG PCRh11i <br />n,�., <br />