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BUILDING PERMIT APPLICATION /! <br />Applicant To Complete This Form <br />If more than one building is to be constructed, submit a separate permit /f/r <br />• application for each building. A separate permit will be issued for each <br />building. <br />° Yrt�� Owner 1 `,�yl. 0 j p��Y`�,Qf`(i Building Address 1 - ��n ;� _ <br />Addresa1. 1 ���t� , Lot Block <br />City '� Phon .r - 3 Subdivision (Plat) <br />Architect/Engineer <br />i City —�� Phone_ Metes & Bounds (Unplatted) <br />j ContractoC 119 �. Q Y,�L a(5& h-,) Sec. 'Twp. _Range <br />I 1 <br />Addr[1esl ( %1� <br />Cityl k%A xo t _PhoA Buil e_ <br />State License Numbe��Q'\j-OI--I)42S Describe Work to be Done_ <br />Expiration Date <br />SKETCH PLOT PLAN BELOW <br />Use of Building..V�_v <br />MNew E]Addition (�jjRepair/ Remodel <br />Valuation of Construction $ /���. on <br />PLOT FLAN REQUIREMENT'S <br />Indicate lot size, name of streets, <br />indicate location and width of alleys, <br />locate proposed and all existing <br />buildings, show distances to prop- <br />erty lines, show distances between <br />buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Number of stories <br />Basement <br />Signed B Date <br />For <br />Owncr Phone <br />THIS LINE - FOR CITY USE <br />Date Received <br />Plan C ✓f k Number <br />Valuation i Ic 0 <br />Permit Fee 14. �11 <br />Plan Check Fee <br />�t AA p0 <br />Total Fee Due ef-c,r.. <br />Date Issued <br />Use Zone_ <br />Fire Zone <br />Occupancy Group_ <br />Type of Construction <br />Occupant <br />Sprinklers Required <br />