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BUILDING PERMIT APPLICATION <br />lete This Form <br />� �'C,7/ 5�/� <br />- Applicant To Comp • T/�/�3 <br />If inore than one buildinq is to be constructed, submit a separate permit ap- <br />plication for each buildinq. A separate peimit will be issucd f:or cach build- <br />� <br />ing. .. '.: _ � / cl i �`�1� <br />��� �� k 'Duilding T+ddress i< � <br />\ Owner i ir i� /{ c.:`�(`/ �"`"`� Cc'. i <br />• �Lot t 4'1� Dlk._3,� Sec.�P��K fc <br />� %L u [ � �/ �1. <br />Address ("7/i ��_ 1 ���- . (�Lt1�YT� VV��gd` <br />` City L-� c�-- Yhone ,__ <br />TwP• R9�' ptv� � y�.�ic 4 Y Ii�c...�5 <br />, t Subdivision (Plat) • � c..kn1+=-=�� � °�"�'// <br />Rrcnitect t � t « <- <br />City <br />Phone _, Metes & Bounds (Unplatte9)�— <br />� Contractor __ <br />pddiess <br />Phone�_ Building Use Y't 5� cf �� <br />City __ <br />� � DescriUe S:or}: to &e Done �__ <br />State Liccr.�^ Numbe= _ _ <br />/ � '� <br />Expitation Date�— �— _ � <br />� - <br />�, l�vo v�u� e ei' S �� ci �y."- �' �•p �•, S�`� Use of Building <br />� u. .c 7 t r 1. - a J`e v V' a. L i t F v¢ �-� t. <br />t.. Cc.�. pici--e. �u�u�h�tis w�r1C ih <br />� New _ Addition R air P.enodel <br />• I,4ci1-c, rco o� ' Valuation of Construction $�1 ��� _ <br />��J . l=r+�..t cc ( L �oct wa % 5'1 V.LI"� w t°c��°•" PLOT PLN`I <br />y�, �,,o✓,��ti ('ONk�4FICy «k�l ��'�-�<« Zn�icate lot size, name of streets, <br />� indicatc location and width cf <br />roY4c�,,_.f �c �' f��ur.�T :�ta �� re'�r al:eys, locate pr000sed ar:d ell <br />y�u �c 1� �s, . . � er.isting buildings, show distances <br />. to px'operty lines, sho�v distances <br />`J , l�.'o v�ci<. jn «u.�,� ✓'.c r Lf �-'a i' �vc �i f between buildings. . <br />ci k c� r-c-4 v f 7'-c p 5 Lot .ize X , <br />S.I'. <br />0 �LVC 2rea�— S.F. i <br />'�e , jj { �o.� � r S r-c �� i ut �! T r" �• �7` a uGa Size of F31dg. <br />Number of Stories <br />��"t0.1' �/u �� c. i. Y j' Basement <br />Use Zone_ <br />-�,., - /� � + <br />. . Signed By �l�-� - <br />DaCe lieceived <br />I ¢!z� - <br />Plan ChecY. NumUer � `---- <br />c, <br />Valuation CCr' �� <br />r�=, .�' <br />Permit T'cc_�-- <br />Pli❑ Check Fce_ �"-- <br />Total Fee Due � G�� <br />Pcrmit Numbcr / %/�'l" � - <br />�_l�t ��7��' <br />patc Issucd — <br />Owner. <br />Fire Zone <br />Type oY Constiuction_ <br />Occupancy Group <br />Occupant Load <br />gprinl:lcrs Required <br />APPROVED fOR E3UILDIfJG PERMIT <br />n.,�,. <br />