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BUILDING PERMIT APPLICATION / V / • •�) 0 <br />Applicant To Complete This ?arm <br />If more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each bui ing.}b. <br />STD S C . <br />Owner /SosiI of Evr.r� _ Building Address �O? <br />Address 71e P­ l-,r Xm, - t Lot Block <br />City L-�,�a1•%J`- PhoneA579- UO// Subdivision (Plat) `/(_ L <br />Architect/Engineer Aire <br />City hone ors -Soil- Metes 6 Bounds (Unpl)7atted) <br />Contractor /eA.✓/ �f' 1. r7` <. s.� Sec. Twp._yK� Rge .S <br />Address Z-01 Aiw 9J 6 <br />City Le5,,7, - Phone %ry- 9/9i Building Use ,fi� f. ./%v <br />State License Number .2z3 - n/ - VX04 Describe Work to Be Done T,,., 4 /, <br />Expiration Date <br />SKETCH PLOT PLAN BELOW <br />r .i Niy vc=_�•t 7ici/4 <br />Use of Building <br />❑ New S Addition ❑ Repair/Remodel <br />Valuation of Construction $Axeo <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 buildings,.show distances <br />to property lines, show distances <br />between buildings. <br />Lot size z.f <br />• Lot area Sq. Ft. <br />Size of B13g.— [ bb Sq. Ft. <br />Number of Stor ei s i <br />•' Basement ,{/D <br />Signed By <br />For <br />(Owner Phone <br />DO NOT WRITE BELOW THIS LINE -FOR CITY USE ONLY <br />Date T'cceived -74- U,.e Zone <br />Plan Check. Number / `r -� Q Z Fire Zone <br />Valuation ZZ� ^� Occupancy Group \/ <br />Permit Fee (�� Type of Construction <br />Plan Check Fee �� Occupant Load <br />Total Fee Due _'i3 Sprinklers Required I^a d <br />Data Issued <br />