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IIUILOING P�RMIT TPPLICATION <br />Applicant To Complete This Form <br />i�`9�f <br />3/r�� �.- <br />If more than one building is to be consCructed, submit a sep�rate permit ag- <br />plication for each building. A separatc permit will bc issued for each build- <br />ing. <br />Owner ,4 �►C V ZK E <br />AudressJll �y� Y� <br />Citytu���_ Phonei�i•�%O� <br />r��n�t��t �,,•3w .te�/ <br />CityS �y tl i� A. Phone <br />• <br />Contractor C� i t� =N t <br />Address� l i� i�� a1I'� <br />City � V {r� 4w Phone�_ <br />State Licence Number' ==s �Ol� �i ��t� <br />Expiration Date q �Z% � % � ._ <br />Building Address � <br />Lot�_ a�x._�_ sr+� 6 R <br />^,'wp.__ Rye. <br />Subdivision (Plat)�jJ���A�_k <br />Dtetes & Bou:ids (Unplatt.ed) <br />Building Use S F ��t <br />Describe l9ork to Be Uone �•�.�� �/{�i <br />Use of IIuilding <br />rF7ew P.ddition Repair/Reno3el <br />Valuation of C:onstruction $ <br />PLOT PLAN <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildi.ngs, snow distances <br />to property lines, show distances <br />between buildings. <br />Lot size 100 x <br />Lot area S.F. <br />Size of Bldg. S.F. <br />Number of- Stories 1 — - <br />Basement <br />Use 2one <br />Signed By <br />For <br />Owner <br />DO NOT l4RITE 6EL01•] TNIS ISNG-FOR CITY USC ONLY <br />Date Received ��7-'� 5� Fire Zone <br />Plan Check NumUer � 75 -i S Z Type of Construction___ <br />Valuation � Cccupancy Grou� _ <br />Permit Fee� <br />Plan Check Fee <br />Total Fce Uue <br />Pcrmit Nunil�er_ <br />Dat� Issucd <br />Occupant Load <br />Sprinklers P.equired <br />�;v a� <br />�iVsrc� <br />