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If more <br />BUILDING PERMIT APPLIGATION <br />Applicant To Complete This Form <br />to be constructed, submit a separate permit <br />�A separate permit will bc issued [or each <br />/ ��/� <br />�� � 7S <br />Building Address��,�_rl U���,_�J <br />i. <br />Address�('[)�{�(Y')\\f1tv1C` _��%1 li0t Block <br />Cit '�Phon �•�'Subiiivision (Plat) <br />Archilect/Enginccr <br />City�_ <br />Con[rac <br />P�tetes & Bounds (Unplatted) <br />Sec. _Twp. _Range <br />\ <br />Ci�\�j\L�' Phon��� uilding Usc <br />State License Numbef��j�j•�i�-� ���.��Describc lVork to be Done <br />Expiration Dale (�-.'�(�-`I Y7 �l�'1-,�,f-�f ��`'(�.�r����� <br />�� . <br />SKETCH PLOT PLAN BELOW J <br />�� �' l-�� J aS �. � � Use of Buitding <br />1 <br />- G . il . U_ . J <br />�c]�n �i�.:,. �-G1}�{\c``�l j�lL.� ��.�. /U 1.��-t ONew ❑Addi[ion ❑Repair/Remodel <br />�W� ��N o�i� ���- 1"I� ��,�c. �� �i1� ValuationofConstruction S p�� } L� <br />�o„ � �'��,aa' i� (?oi� 'r�. a�. <br />c�`j° 3'7' '�c,' L- 150' �� G`li�'3c „ <br />�`l0 ' ih 1� R9 ` 3�1' 5�: �� �J i�c; „ <br />'it� iJ r� ,l�-i, ��,,, �.J ���,, i;,n-E <br />Date <br />PLOT PLAN F2EQUIREMLNTS <br />Indicate lot size, name ot slrcets, <br />indicate location and width o[ allcy;, <br />locate proposed aed alt existing <br />buildings, show dis[ances to prop- <br />er[y lines, show distances Uetu�cen <br />buildings. <br />Lot size <br />Lot arca <br />Sizc of Bldg. <br />N�imber of s[ories <br />Basement <br />Sq. Ft. <br />Sa. Ft. <br />Signed IIy Datc <br />�_ <br />For � �--.���,��� �i-�;�,.,ti. <br />Owncr Ph n�rr c <br />Use <br />Plan Check Numbcr t'ire Zone <br />(o O <br />Valuation �Z-�S . OccupancyGroup <br />�yc> <br />Pcrmit Fec I 3•- _ Typc of Construc <br />Plan Check Fee <br />e. �- <br />Total Fcc Duc (�• ' <br />D. tc Is <br />Occupant <br />Sprinklers Required <br />