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BOILDING PEitMIT APPLICATION <br />Applicant To Complete This ^orm <br />• , _. .�L' <br />., . .j ��K� / .::;� . <br />' If more than one buildinq is to be contructed, submit a separate permit applica- <br />� ., tion for each buildinq. ]1_separate permit will bc issued for each building. <br />. ' ' Orner ��� h ,! � � � Suildinq Address �7 � �- .J /�i�" ' - <br />. ' ]Iddress y� Ji Y �- �� `�/��' Lot Block _ . <br />. • Clty � s-a- � • 1'hone � S � c=C �c Subdivision (Plat) S�C%� � � ' <br />` ' 1lrchitect/Enqineer __—�- <br />�(�� �/� �Ic�i� D`/ �f-3�-.{ . <br />. i <br />"'� City Phone Metes 6 Bounds (Unplattedl : <br />_i � J ��Sec. �� 1Y+P. a- % Rge � 7- <br />. . � CODtIdCLOL -{ cJ .t Q f �-, ' . . <br />:. . , Jlddress � YiD - � (L -�. � / • <br />_ / • �. <br />!; �ty C ���,( Phone !� Z-�� Buildinq Use . '`f; =. ;;_.. <br />.�-; : ., �.r'�'� � -:,:;�.,: <br />. tj State License Nu:aber ��- 30 �- c��� Describe Work to He Done _ <br />� . . ;� L�cpiration Dat� <br />��� ��� � SRETCH PLOT PLAN BELOW' ' ' <br />�' . �� � Ose of Building <br />. . � � � �--� . . <br />, _ L]New ❑ Addition [I Repair/Rem�u�el <br />i <br />' � �• , `. � . . • ' ,� . � ' . � . � � Valuation of Constructic�n $ �J� � <br />• , � � � • ' � . PIAT PLAN REQUI�IENTS S� -�C� . <br />,,,... , . ... � . . � <br />�r / / • <br />� 'G <br />• i .�U <br />. .� . <br />:'.� <br />. . ` ; . <br />. <br />.. .:� <br />s^1'F• <br />. J <br />. .: � i. <br />.!i. - <br />� S � �� <br />� DO NOT� S�Z T� , <br />!;ate Seceived <br />% <br />- Ind3.cate lo: size, name of streets, <br />' �indir.a*e l�cation and width of <br />rlieys, locate procosed and all � <br />� existing buildings, show distances <br />., .. to property lines, show distances <br />- betaeen buildings. <br />�T r'�iOS'7 ' <br />� <br />7� <br />F]an.C,zeck :lur.�ber _�- <br />�� <br />Valuation =� �-'�� <br />� � <br />Pernit Fee �� <br />`--�" <br />Plan Check Fee ' <br />� r c� U <br />Total Eee Due - `— <br />i i <br />Date Issued �7�7/7 I <br />� � . . <br />Lot size x_ <br />Lot area Sq. Ft. <br />Size of Bldq. Sg. Ft. <br />Number of Stories <br />Basement <br />,� <br />Signed By � J �+¢� <br />For ��� �'� <br />ner hone T %G,�_T <br />USE <br />U�e Zone <br />Fire Zonc <br />Occunancy Gr.�ii� _ <br />Type of Construction <br />Occupant Loac1 <br />Sprinklers Requ.ired <br />