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DL'ILDING PERMIT APPLICATION <br />Applicant To �omplecc This Form <br />i`��'�� <br />3�3j�j� <br />� if more than one building is to be constr�r,ied, sut�mit a separate permit ��- <br />i' plication for each building. F� separate Fm:mit will be issued for each build- <br />I 1 ing. . � <br />I �'. , (lwner �; � > I� i�, i��_— suilding naares� �r'L/ �/ �{'( I')ri U( , <br />` � Address1��� nCi .� PO ��F /7 / � � � . Lot�•a 1 Dlk. �� Sec. _ <br />� city �l9b% Phone �?-G 9�/ TW'�. Rq�. <br />Architer,� _ ' SuUdivision (Plat) � �� �+��h �-� ��'l'�'���� <br />. <br />City Phone__ <br />ContractorJ�O v � �0l S/Y� �a7+�1 <br />Address <br />CiL•y _ Phone <br />State License Number' <br />Exriration Date <br />��1r � <br />Afetes & Dounds (UnplatLed) <br />Building Use �i-D�PX U�%7�Q � <br />DescriUe t•]ork to Be Done . <br />Use of Buildin9 <br />�lvew Addition P.epair/Fenodel <br />Valuation of ConstrucCi,on $ ` Y') <br />. � PLOT PLnN <br />Indicate lot size, name cf streets, <br />indi.��atc location ar.d �.idth of <br />alleys, locate proposed and all <br />!- a����t�`'� c�:i:sting buil.dings, show disttmces <br />!.o;- 1J � to pioperty lines, alicw distances <br />between buildings. <br />o�r wRi�re arr.oia <br />� <br />Date Received � _ <br />Plan Check Numb . �L�— <br />Valuation ���a �� <br />Permit T'cc r � % � � <br />Plan Check Pee �Zr( 5 � <br />Tetal Fce Du�a>�i 7S S�� <br />Permit Nunil�er�� � � ' ^._ <br />Date Iesucd ��3/�7� <br />Lot �ize .�/� X � 7 1 �� <br />� Lot area /� nnn� S•I�• <br />Size of. IIld� S•r.• <br />Number.of Stories �� — <br />F3asement jl% \ -- <br />Usc 'Lone — <br />Signed lly (,�i� �r��A "�O ^�)r��J <br />For ,( IAn � s" c/ �'� ,� ,� p ,� `_ � <br />Ownnr <br />s r,7tas-r•oa ci�rv use ONLY <br />I'ire Zone � <br />Typc of ConstrucL-ion �- ��i <br />Occupancy Gioup N <br />OccupanC 1.oau <br />Sprinl:lcrs Iiequired <br />APPROV[D FOR DUILDIfdG PERfv11T <br />