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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />��yy� <br />If more tnan one building is fo be constructed, submit a sepaxa[c permit /� y/� 5 <br />application for each building. !4 separate permit will be iesued for each <br />bnilding. . <br />O�vner �l�`1� ti� �S�JLY.Q_fYY`LLv�lBuilding Address a�(l ) /`� �� <br />^ 6 �fc ck'���-' <br />Address t�l �J 1Q�' Lot �.'� �-//.. Block � <br />�� p i <br />City� \9.A�i4� Pho� Subdivision (Plat)�C'��`� rY+� r�'1 nlL�oY' �_�.- �.iJ: r7;`.�f , <br />neer <br />Phone <br />�\ e . <br />Metes & Bounds (Uaplatted) <br />Sec. Twp, _Range <br />Address'" ( , lf 9 <br />C�ty�tip'�'Q� '� ne�., Building IIse <br />State �License Number�'�:���-��- � �`YG� Lescribe Work to be Done <br />Exoira[ion Date c�-� -�jS� \ ` <br />- � _ <br />SKETCH PLOT PLAN B�LOM <br />DO NOT �VRITL SGLOW <br />Datc Reccived % 4r 7 <br />Plan Check Numb..r <br />Valuation� �rfi � <br />`l' <br />Permit Fee /�.[p • � <br />Plaii Check <br />Use of Building • � <br />II Neµ� ❑ Addition f�Repair/Remodcl <br />C,C; <br />Valvation of Constrcction S I f�� <br />PLOT PLAN REQUIREMENTS <br />Iudicate lot size, name of strcets, <br />indicate location and width o( allcys, <br />locate yroposed and all existing <br />buildings, show distances to prop- <br />erty lines, show distances between <br />buildings. <br />Lot size <br />Lot area <br />Size of Bldg.___ <br />Numbcr of storiec� <br />Base=nent <br />Sq. F[. <br />Sq. Ft, <br />Si By Date <br />� <br />For �_ '1� � ���-� <br />Owner Phone - � <br />- FOR CITY US:m' OtQLY <br />Use Zone <br />Fire Zonc <br />Occupancy Group_ <br />Type of Gonstrcction <br />Occupant Load <br />r�7 <br />Tote.l Fec Due !�r �' Sprinklers Required <br />Date Is <br />