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t <br />uvauva+��+ rnnma a nrra+�a.n aav�� . <br />' • ' Applicant To Completo Thio Form <br />. . . ; � y�.3� � <br />II mote than o09 bultdiag ie to be conetructed, �nbmit a�eparate permit -, • <br />. appflcation for each building. h ueparate permit will be issued for each ,/.3/ S <br />. bailding. ' , ' . . <br />Owner -�CtVU �). �.,CIYCP 1'� Auildiag Addre��, '��-i � I �o VCI 11ci G'� I1� . � <br />• J <br />Addre�s `��iu9 �r��lllPll;u'KJ..Lo! {rJ�)�Block � - <br />, Cit��n��h�•m��h �one 33`I-Ina`I��Subdivisioa(Plat) �'� <br />.• Arehitect/Engineer � � � ' <br />��t� Phoae Metee & Bounde (Unplatted) � <br />Coatiactor Sec. Twp.. Range _ • <br />. Addrubs . • . <br />�ty. � P'ho¢e Building Use <br />� - Sbte Licenee Number � Deecribe Work to be Done ¢� v� n <br />ExyitatioaDate p��Y�. �-P�el� LF%C."� GC -�!PS. <br />SKETCH PLOT PLAN BELOW — _ � � �c <br />. ��o yN - <br />' ' Uee oE Bnildiag <br />• . . . - '.. . . : � , �. ' . . � ... •�New �ClAddiHon 'IIRepair/Remodel <br />• Valuatica of Conatruction $ <br />� . . • � . ' PLOT PLAN REQUIFtEMENTS � <br />i.: ' <br />t .' <br />' '• � Indieate lot size, name o: atreets, <br />� , •� � ,. : -. � ��indieate location and width oE alleys, <br />- � � ' � - - � � � � � � locate proposed and all existing <br />� .. � . � � � �. .. �� � . � � • � buildiaga, show distances to prop- <br />� � � ' � .� � .� • . , � ' erty-lines, show distances between � <br />. huildinge. <br />� .. . . .' . .' 'Lotsize x � <br />. _ • . Lo! srea Sq. F!. <br />• ' .. Sise of Bldg. Sq. Ft. : <br />. . ' Namber of etoriee <br />, . � Basement <br />� <br />. ' .. . � • • �SigaedBy�'�i+ r,�n Date3-%-7\ <br />.For <br />' � . . , , . Owner _ Phone <br />� DO NOT WF.ITE� BELOW TIiIS LINE - FOR CITY USE ONLY <br />� .Date Reccived 7-�-� S Use Zone <br />PLn Check Num6er _ Fire Zoae , <br />, , . <br />Vtluation � OecupaneT Group <br />Permit Fee Type.of Cone[ructioa <br />� P11n.Cbeck Fec OceupantI,oad � <br />Total Fee Due • '' Sptinklere Required <br />Date Ieeued � ' • . , <br />. i <br />