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BUILDING PERMIT APPLICATION / Fr••"( O <br />Applicant To Complete This ?orm <br />If more than one building is to be contracted, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each buil ing4tl 5 <br />, <br />Owner /Spp asrlt' 01&� ET•e— Building Address <br />Address i o�� o, Ctiel�in.•-�L Lot _ Block <br />City L*„r.-r %%— L`Phone�-9 - d o// <br />Architect/Engineer //w•-�e- <br />City , ,.r..?Y PhoneSoiJ— <br />Contractor lez. _._,l l J,- (, s. � <br />Address f mew 9.s 8 <br />City Phone Y/9i <br />State License Number .2Z3 - o/ - %&a.l <br />Expiration Date <br />SKETCH PLOT PLAN BELOW <br />r.. <br />Subdivision (Plat) �4— f_ <br />Metes 6 Bounds (Unpl)atpted) <br />Sec. �Twp. , XQ Rge <br />Building Use .L'Fc.1T , <br />Describe Work to Be Done �, /..// _ <br />/ eye+/vL - 7 7/rl x'5Z <br />Use of Building <br />❑ New 2 Addition ❑ Repair/Remodel <br />Valuation of Construction $ 3.Aco <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 Ai x ;,X <br />Lot area Sq. Ft. <br />Size of D g. , b Sq. Ft. <br />Number of Stories t <br />Basement W40 <br />Signed By axc <br />For F -- <br />Owner Phone <br />DO NOT W�RrITE BELOW THHIS LINE -FOR CITY USE ONLY <br />Date Received /7.23-%�• /f/- Ute Zone 4F — <br />Plan Check Number -PQ Z Fire Zone 3 <br />Valuation -vZ 0O occupancy Group T <br />Pomit Fee <br />Type of construction �' N <br />, <br />Plan Check Fee � occupant Load e05 ' - <br />Total Fee Due ?? Sprinklers Required <br />Date Issued ' <br />