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BUILDING PERMIT APPLICATION <br />A 1'scat T C I t Th' <br />pp n o omp e e is _orm <br />If more than one building is to be contracted, submit a separate permit apolica-��/. <br />tion for each building. A separate permit will be issued for each building. <br />Owner �('^7j 1,E q 3C \� Lk L�) Building Address <br />Address ZSt�'y' �ca�' Lot_ Block n l� <br />City " e Phone_ ;�_ -C_%3� Subdivision (Plat) nn rt/ U)_�Cd <br />Architect/Engineer �( �� c`�PC�ro <br />City Phone Metes & Bounds (Unplatted) <br />Contractox�i—'L �� ' del s L-9 cuhn Sec. Twp. Rge <br />Address <br />City--Lyu ' Phone �1b( Building Use <br />State License Number Describe Work to Be Done <br />Expiration Date �— -�( `"� -t C; ` Q'C' C�- C2' ,•- 0 ?,.n <br />SKETCH PLOT PLAN BELOW <br />Use of Building <br />0vew ❑ Addition ,.[IRepair/Remodel <br />Valuation of Construction $ <br />PIOT PLAN REQUIREMENTS <br />• Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings,.show distances <br />'A to property lines, show distances <br />between buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number of Stories _ <br />_Basement <br />Signed By <br />Fo <br />Owner Phone <br />DO NOT WRITE BELOW THIS LINE -FOR CITY USE ONLY <br />Date .._ceived U,-e Zone <br />Plan Check Number <br />^ Fire Zone <br />Valuation �'\x'�,.� Occupancy Group <br />Permit Fee Type of Construction <br />Plan Check Fee Occupant Load <br />Total Fee Due Sprinklers Required <br />Date Issued CITY OF EVER' iT <br />APPROVED FOR BU;LC':.. "li F <br />Date <br />Dy:'- _ <br />