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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more than one building is to be constructed, submit a separate permit ap- 3///S <br />plication For each building. A separate permit will be issued for each build- <br />ing. <br />Address 30 EO <br />City at,A'C iit•i• Phone <br />Architect__ <br />City Phone <br />Contractor �pZ &' <br />Address Q <br />City_'�3. 4c j . Phone, / Y- JS <br />State License Number' <br />Expiration Date <br />T <br />-6( 4 (��' tni.i !mod icy )Cl C f �G( <br />WRITE BELOW THIS <br />Date Receivedf�— <br />Plan Check Number <br />Valuation <br />Permit Fee <br />Plan Check Fee <br />so <br />Total Fee Due ".:?3. <br />Permit Number /T 5- <br />Date Issued_ Ll Z-5 <br />Building Address';: <br />LOLIZ-/(P Blk. 9 sec._S •/�BEc�yYy� <br />Y'tvp. Rge. <br />Subdivision (Plat) <br />Metes & Bounds (Unplatted) <br />Building Use <br />Describe work to Be Done <br />Use of Building - <br />- New -. Ade 'tion . Repair/Renodel <br />Valuation of Construction $ <br />PLOT PLAN <br />Indicvte lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distances <br />tj property lines, show distances <br />between buildings. <br />Lot- size x <br />Lot area — —"-- S.F. <br />Size of Bldg. _S.F.. <br />Number of Stories <br />Basement <br />Use Zone <br />Siyne y <br />Foq d <br />Owner <br />USE ONLY <br />Fire Zone <br />Type of Corstruction <br />Occupancy Group <br />Occunanc Load <br />Sprinklers Requi <br />APPROVED FOR IIUILDIN;; PERMIT <br />