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.• BUILDING PERMIT APPLICATION <br />Applicant To Complete This corm <br />If more than one building is to be contructed, submit a separate permit applic i/-;S <br />Lion for each building. A separate permit will he inrsued for each Jbuilding. <br />Owner w !�ii✓/ _ Building Address <br />Address A-b,.,.l Lot `( Block <br />City C Phone Subdiir' (Plat) /5 <br />- Architect/Engineer <br />City Phone Metes s Bounds (Unplatted) <br />Contractor, �i <br />_ Sec. Twp. Rge <br />Address, //7 S <br />�. city,: �` . Gt•-*-,a— Phone �i`��7�.��L� Building Use <br />sl State License Number-.12 -N-J7- Describe Work to Be Done •"• <br />( Expiration Data '7-/— ? i <br />SKETCH PLOT PLAN BELOW' <br />Use of Building <br />.. - L•INew ❑ Addition p / ❑ Re air Remo:iel <br />Valuation of Construction $ <br />e <br />1 <br />�r <br />DO NOT WRITE BELOW THIS <br />Date ?received 7L/ 'J 5'- <br />i <br />Plan Cz.cck ;:umber 75• -� ](� <br />Valuation <br />Pemit• Fee <br />Plan Check Fee �J&C, S-D <br />Total Fee Due pl• <br />Date Issued <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing building., show distances <br />to property lingz, show distances <br />between buildings. <br />Lot size X:5-0- x Sf'Z <br />Lot area q/•9 Sq. Ft. <br />Size of BldgSo. Ft. <br />Number of Stories <br />Basement /J <br />Signed By ,a 7#, /�a2L �C<< 2 n•r/{�� <br />For <br />Owner Phone <br />LINE -FOR CITY USE ONLY <br />U,e Zonc <br />Fire Zone <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />