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BUILDING PERMIT APPLICATION /�oC ✓ 'J <br />_ <br />Applicant To Complete This ^orm <br />If more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. <br />Amer 'j P • ��[t• (� 7 /7 <br />Building Address .. /o ? � fs., <br />/<e <br />SIA Si <br />Lot Block �/ y 3 <br />Address •,%� lJ 7Q_ <br />_ <br />City rtf0 Phone 7,!; 3—'57H, <br />subdivision (Plat) <br />' <br />• <br />S /�rC_�D �645 rc){,'�v� <br />- <br />Architect/Engineer - �� <br />Ci_ Phomn <br />Metes i Bounds (Unplatted) <br />R e <br />Contractor aau i/ + r , Sec. n+P• 9 <br />Address J- <br />. ' <br />City /4L/r r d Phone %71'' l-/Efl <br />Building Use <br />i <br />State, License Number <br />Describe Work to Be Done <br />. <br />I <br />Expiration Date <br />SKETCH PLOT PLAN BELOW <br />- <br />'� <br />Use of Building e- <br />{ <br />QNew ❑ Addition ❑ Repair/Remodel <br />• •. .i <br />Valuation Of CORStrUCtlOn $ ^� �b <br />i' <br />_ <br />- <br />PLOT PLA2I REQUIRE.'IENTS <br />Indicate lot size, name of streets, <br />+ <br />1/ <br />-indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />• �•? <br />• i'ri <br />_ .,y .�+� <br />to property lines, show distances <br />between buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />"••: <br />i <br />": 4�;• <br />Size of Bldg. Sq. Ft. <br />' <br />�,� <br />�• <br />Number of Stories _ <br />•i �.�` <br />Basement <br />• <br />.. � <br />�Dy r )�/t „ - <br />Signed <br />For <br />. <br />Owner Phone 9<-, <br />Do NOT WRITE BELOW THIS LINE -FOR CITY USE ONLY <br />- <br />Date Received <br />Dee Zonr <br />' <br />Plan.Check Number <br />Fire Zone <br />Valuation <br />Occupancy Group <br />Type of Construction <br />Permit Fee <br />Plan Check Fee <br />Occupant Load <br />Sprinklers Required <br />Total Fee Due <br />Date Issued• <br />_ . <br />