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e <br />BUILUING PERf4IT APPLICF�TION <br />Applicant To Complete This Form <br />� J �-' ' . .�' <br />� � ,, <br />,j�i��.! <br />If more than one building is to be constructed, submit a separate perm�t ap- <br />plication for each building. n separate permit o�ill be issued for eacti k:uild- <br />ing. <br />Owner ♦�k'J.iN N � Building Address � � <br />Address �� 7/D �c��'iS'.J G� . Lot B].k. Sec. __ <br />Cityrrv�Y�� Phone 25 9 � Twp• Rge. _ <br />I�rchitect <br />City <br />Phone <br />ConLractor �� <br />Address <br />City Phone <br />State Lir.ense Number _ <br />Expiration Date <br />Subdivision (Ylat) <br />Metes & IIounds (UnplatLed) <br />i � <br />Building Use P L.�--�- <br />Describe 41orY. to IIe Done <br />R P,�l� �� z �'/oo�- ,,'.,�s fr <br />� 7` D <br />Use of Buildi <br />'__New � Addition Repair/I?emodel <br />Valuation of Construction $ ��. <br />�-- <br />PLOT PLItN <br />Indicatc lot size, name of streeLs, <br />indicate location and wicith of <br />alleys, locate proposed and al]. <br />existiny buildings, shoor distances <br />to property li.nes, show distances <br />between b�ildings. <br />Lol size x - <br />Lot area S.r. <br />Size of llld9. S•f'. <br />Number of Stories_ <br />Basemr_ut _ <br />Use Zone �� <br />Signcd Dy.�y� ' <br />.'or — <br />04mer <br />DO NO'1` l']]tITB BPLOh' '1'HSS T�INL-F'OR CITY USL'' ONLY _ <br />llatc-�Reccived Firc Zone <br />Plan Chr_ck NumUer � _ Type of Construction <br />Valu�tion Occupancy Group <br />Permit <br />Plan ChecY. Pee <br />Total Pee llue <br />Pcrmit [dumber <br />D<ite lssucd <br />Occupant Load <br />Sprin}:lers P.equi.rcd <br />APPROVED IOR f3UILUING PERMIT <br />� <br />