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AUZi�DIP1G PPR1�ffT APVLICATION <br />AFplicnrt Tu Compiccr_ Tliis 1•'orm <br />,�r <br />; � <br />j; <br />/�-r ii� �S— <br />If more than one building is to be constructed, submit a separate permit ap- <br />plicati.on for each building. A separate permit �vill be issued for eacii Luiid- <br />inq. <br />Owner . !'[ i��;ni ,.,��_,q- c- - <br />,, <br />Address d� i-�. /n•� .J "( <br />City ;�-�: Phone <br />I� chitect <br />City <br />Phone <br />Contractor �'�-•-,..,,. ;'-,-��- � " <br />A(�dTe55_/�, /��,'v �1 �' � � <br />City /-��..- �.. - Phone-- <br />State S,icer.se Number <br />LxpisaCion Uate <br />l9RIili <br />Ur:Cc-,It_cei.v�d ( �',eo ��`S' <br />Plan Cl�eck. I.umber � �7`�� �:-�32 <br />V.,].u?tion ��7 `=,Z`�• ��' _ <br />Permit I'ce / c/- L"_ <br />Plan Checl: Pce ���-�� �� -_ _ <br />7'oLnl Y'ce Duc i � `'� <br />i <br />rormit Nuriber �9L-�/ i_i __ <br />D:iC.c :t::_:r,�:�l /��./i/_Z1� ----- <br />7 7 <br />IIuildin9 nddress �„�j "" �� D�• 5�• <br />Lot ')� IIlk. Sec. <br />Twp.__ Rge. <br />Subdivision (Plat)1�����,i,�r,,�.:'I.��rr:' :;_� <br />Metes & Bounde (Unplatted) _ <br />Suilding Use <br />Decc�ribe S�lork to Be Done _ _ <br />� <br />1, n :.: /f ,(,.' C' --- <br />Use oi� huilciing ���=� _�it� �-�' <br />i <br />'�New � Addition Repair/Femodel <br />-'%S�.S.��'— <br />Valuation of Construction $ �- __ <br />PL03 PLIu� <br />Indicatc- lot sire, name of streets, <br />indicate location ai:d �,idth of <br />alleys, locate proposed and a].7. <br />existing buildings sho�a disf�inces <br />to property lines, sho» distcmces <br />betareen Luildinys. <br />LOC size >' <br />I,o- area •1�• <br />Si.ze of. Bldg. _S•�''• <br />D7uril�cr. of Storics _ <br />Basemcnt <br />Usc Zonc <br />/ � j <br />Siunecl f3y % �� � "�„��r,._= <br />:or.�l�„ ,,� /� s' -ri. �. <br />namer <br />1�' 'INli-T•'OI2 CTTY USP. OF],Y __. <br />Pire 'Lone �''-> <br />Type of Construction <br />Occupancy Group__ <br />Occupant I.oad <br />SprinYlers <br />i�,r�r�r,o���� ro�z �ui,.n,r�,c r�rr,�;;�r <br />u.�te.!'::___: -'----��y ' ---- <br />r. <br />