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_ y. __ - � <br />'r <br /> i <br />� <br /> i <br />, . . . . . � - <br /> 1 � ' BUZLDING PERMIT APPLICATION � � � „� <br /> i -- � Applicant To Complete This ?orm ` � � �� <br />� �. . � . . , � �� J.J��: <br />, • ' If more than one buildinq is to be contrucced, submit a separate permit applica-;; <br /> tion for each buildinq. �1 separate permit will be issued for each building. �- <br /> ' ' prmer MRS •�/ S, Q�fGrA/{c1 Building Address t � � D ' 3 7� �Jfi. <br /> , Jlddress ' I� N E• � 7S�S� Lot slock 1 Z � <br /> . . City �►r�- E1L Phone Subdivision (Plat) ' <br /> ' - �zchitect/Enqineer �Ay��' , �' � �� � �l'`'L � � � <br /> _ . � <br /> • '.+ '"� City Phone Metes 8 Bounds (Unplat:ted) _ <br /> - - _i <br /> _ :, Contractor Ay�� ("ow:7; �IV�. Se�•_ TWP• Rge <br /> � . � aaar�55 G S'1�" ,QevEatv 6t..1 . . � . <br /> - - � �/ , <br /> ' City FIERE� Phone 9 �C�Z� Suilding Use A1�R EMpfd S E ' :': -s . . <br /> - � . ��i � State.License Na�nhher ,Z� 3 � d� `��� 7� Describe Wozk to Be Done p� '� `.^�� �� <br /> � <br /> � . �. '� Ezpiration Dat� �� r 2 /�G � �RmAs"� �jcfl-:S <br /> . �. , <br /> ;� � � � SKETCH PLOT PL7�TI BELOS�T' • , <br /> � • ! � Dse of Building ��F �dld S f, <br /> :1 . . . <br /> �. ' ; : , , ❑New ❑ Addition ❑ Repair/Remo::el <br /> ' � ; _ • � � : : • 'Valuation o£ Construction $ • 0• � <br /> � � • _ . pLOT P7.AN REQUIRE!•LNTS . . . <br /> -....• , .. . , . <br /> ." � • <br /> ' • . ' • Indicate lot size, name of streets, <br /> " .; • ' indicate location and width cf <br /> � • . alleys, locate proposed ar.d all - <br /> ;.• ' " � � existing buildiags, sho:u distances <br /> ,1 . _. . .. .o : , � . . to pioperty lines, show distances <br /> ' , _• • betweer. buildings. _ I <br /> ' Lot size X <br /> � � Lot area Sq. Ft. <br /> � �� • � Size of Bldg. Sa. Ft. <br /> � '•' � Nwnber of Staries ' <br /> � ; .. . <br /> � 3' ' , Basement _ � <br /> .- � � <br /> •� .. �- Signed By � <br /> For <br /> ' ' . Owner Phone 2 <br /> ' DO :IOT S'Z?T' BELOt] THIS LI:1:-cOB CITY USB Oi7L'1 <br /> Date ��ceived Uce Zone <br /> ' Plan C:1eck ::u.:.ber � ' Fire Zonc � _ <br /> Valuation � Occunancy Grou� _ � <br /> Pemit Fee Type of Construction <br /> Plan Check Fee � Occupant Load <br /> ' 1bta1 Fee Due Sprinklcrs Required <br /> Date Issued • , I , • ' � <br />