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BUILDING PERMIT APPLICATION , <br />Applicant To Complete Thia Form _ <br />II mare than one building is to he conetructed, eubmit s eeparate permit � <br />application fox each building. A separate permit will be ieaued For each <br />kuildin <br />Owner��oUALO l, I°'e �0�'N�LLBuildiag Addreea S � p-`.�� ST �..L% . <br />Addreeu �) (-� fY� � ' � Lot Block <br />�: �C ' <br />City ( V� 2� 1 1 Phone �J )-Z':j I� 5uhdivieioa (Plat) <br />Architect/Fngineer <br />City phoue Metee k Bounda (Uaplatted) . <br />Contractor ��_,�; Sec. J�� Twp. ��J Range m¢ <br />Addrees _ �"-- �j�C) <br />City Phone Buildiag Use , . <br />State.5,icenae Number � Deacribe Work to be Done <br />FapiraHon Date <br />.SKETCH PLOT PLAN S�LOW <br />ac, � ° <br />/ i r <br />�bx l� �' <br />ta}D� . <br />3�c�� <br />r of Buildiag���-�,�p,�,� � �� /.Llas4 — <br />%� <br />N.ew �AddiHon � Z aT�°i <br />;QRepair/Remodel <br />uaHoa ot Construction $ �j ('i(1(� , C� � <br />PLAN R.EQUIREMENTS <br />Iedicate lot size, name of streets, <br />indicate location and width of alieys, <br />locate proposed and all existing <br />buildings, show distances to prop- <br />erty lines, show distances between <br />buildinga, <br />Lo! size x <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft, <br />Numher of storiee � <br />Baeement <br />- Sighed B � .f �ate .�_�.-%s� <br />DO NOT WRITE BELOW THIS LINE • FOR CITY USE ONLY � <br />Date Received 3- 1-'1 � Uee Zone �— S <br />Plan Check Number 1 j -� �-� Fire Zoae 3 <br />SµSD �.aV�•:w gii:i�� . . . <br />ValuaEion .»i+, «: �-,k.;,.,� �,paY,.OccupanryGrcup �, <br />Permit Fee ��,<.-.}U �=�r,r Type of Conetruction �j;� -� <br />Plan Check Fee � 3 G.. �W � Oecupant Load — <br />Total Fee Due � ��'i O, � tJ Sprinklere Required <br />Date Ieeued � � <br />