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� BUILDING PE[LMIT APPLICATION /d � / � . '' <br />� ' Applicant-'!'� ['r+mplete This ?orm � ,'�j f� . � <br />If more than one building is to be contructed, submit a separate permit a�pl�/s/�� <br />tion for each building. A separat;: permit will be issued for each buildiny. <br />i <br />Owner 7 i. Huildiny Address �� ��; 22 �t p S7', <br />Address -"� � � � f" Lot i ': ;� Block � <br />. CiY.y _ �_ Phone � - � ' Subdivision (Plat) � � - � - <br />l�rchitect/Eiigineer •� • <br />City __'; Phone Metes s Bounds (Unplatted) <br />. Contractor � - - Sec. Twp. Rge <br />Address ; 'I i - <br />s <br />Cito /> ;,..��. ,� ii_ Phone " Building Use <br />� State License Number .J."�� � - ' Describe Work to Be Dor.e � , - . � � <br />..`J , <br />. Expiration Date �_�� !-� -' i : � � � � _ <br />SKETCH PLOT PL�1N BfiiOW <br />I- _. .. . _ / '/ . <br />r <br />��, <br />t'.� <br />• .. - I <br />� <br />.. i <br />' I <br />Da:� ^.�ceived <br />l�l <br />DO �IO':' [<,',i:i E <br />Ose of Buildiny <br />��1ew ❑ Addition ❑ Repair/Re�nodel <br />Valuation of Construction S G G<.%O <br />• PIAT PLAN REQUIRE6IENTS . <br />Indicate lot size, name of str2ets, <br />.i indicate location and width of <br />alleys, locate proposed and all <br />� existing buildings, show :iistances <br />�� � to property linee�, show ciistances <br />j i between buildings. <br />Lot size �°" ii x /;�'�� <br />� Lot area �. .: �� Sq. Ft. <br />� Size of Bldg. � �,-.,- :- '( Sq. Ft. <br />� Number of St�ries <br />Basement � <br />Pi2.n CYC'.. .�,.C,.,=_ %is�"��o � <br />�%2�lldC10:1 ��%JL�� �C� <br />Pemit Fee ? �/• ��J <br />..-- <br />Plan Check Fee i�y 3• [.- 6�__ <br />Total Pee Due <br />DatC Issur_d <br />S�gnec'. Sy � - t�'.. -- <br />For <br />Owner Phone <br />Ute �one <br />Pire Zonc <br />Occu?ancp Group __ <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />� <br />