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i I .. ,. .. , _ .1 :S <br />BUILDING PERMIT APPLICATION - •;,? <br />APplicant To Complete This :arm <br />1! more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. J <br />Ovaer �� ' Building Address i/U% <br />. Eddress �"% � '% '"]/�"!n 5 , �. Lot Block ' <br />city -u':>< tI1 / Phone /02 Subdi4ision (Plat) <br />Axchitect/Engineer ^,,y r(1 F <br />=� city (�Phone 5 -; 3S 21.4.. Hetes G Bounds (Unplatted) <br />Contractor Ll�. G �/' ��,. Sec. _ Tap. lice <br />lddress <br />'f; city /%� ,_.� ::� Phone 7 9 Y-%XN3 Building Use - i`/7 _ ✓h_":. i.; ►. <br />State. LiceLse Number r ? i-O i,.'?//-a C Describe Work to Be Done <br />. • �I Expiration Data <br />��• SKETCH PLOT PLAN BELOW <br />i <br />:' Use of Building <br />Mew O P.dd: tion Q Repair/Remo:'el <br />i Valuation of Construction $ i 5S .foo <br />"••' PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate procosed and all <br />{ I existing buildings, show distances <br />to property lines, show distances <br />between buildings. <br />Lot size >C c ' x f vo <br />• •• .Lot area Sq. Ft. <br />r Size of Bldg, a k i 2 is Ea. Ft, <br />Number of SL•orles i <br />Basement — <br />. ; Signed By ✓ / <br />For <br />Owner one s? �.v <br />DO NOT S•::iITE BELOU THIS LINE -FOR CITY USE ONLY` <br />Date Soceived _q Z �' Uce Zone ' <br />Plan Check Number Fire Zone <br />Valuation _ / Occupancy Crrcp _ <br />QZ`I pewit Fee Type of Construction <br />plan Check Feey 7 �• �y Occupant Load <br />Total Fen_ Due Sprinklers Required <br />Date Issued <br />■ <br />