Laserfiche WebLink
BUILDING PERMIT APPLICATION /� l <br /> Applicant To Complete This Form (J/ <br /> If more than one building is to be constructed, submit a separate permit •3/i?7/,S <br /> application for each building. A separate permit will be issued for each <br /> building. <br /> Own er\ �&x'11, Building Address ato 66," <br /> Add r ec�(]�� .C� � / Lot f Block n fJ� <br /> �I <br /> City� )i n :J_Phon 5 - •�1Y Sub(.ivision (Plat) rn <br /> C.ffCF tJ'. <br /> Architect/Engineer <br /> City_ Phonep�ry�/��.L,t Metes & Bounds (Unplatted) <br /> Contracto�jLPUA Sec. Twp._Range <br /> Addres _ <br /> Cit r� a��.Phon pBu lding Use <br /> State License Nu/mbeC�C.y� Describe Work to be Done <br /> Expiration Date V7—r� nO�/`6 0 hry-), <br /> SKETCH PLOT PLAN BELOW <br /> Use of Building <br /> = New O Addition 81epaiirr/Remodel <br /> Valuation of Construction <br /> PLOT PLAN REQUIREMENTS <br /> , <br /> Indicate lot size, name of streets, <br /> indicate lorntion and width of alleys, <br /> locate prol osed and all existing ' <br /> buildings, show distances to prop- <br /> erty lines, show distances between <br /> buildings. <br /> J Lot size x <br /> Lot area Sq. Ft. <br /> Size of Bldg. Sq. Ft. <br /> Number of stories <br /> B. sement <br /> Signed By Date <br /> For <br /> Owner Phone <br /> DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY <br /> r <br /> Date Received 3 Z S' ) Use Zone <br /> Plan CheckNumberFire Zone <br /> Valuation t3tl�d� Occupancy Group <br /> Permit Fee C--) Type of Construction <br /> Plan Check Fee Occupant Load <br /> Total Fee Due �- U Sprinklers Required <br /> Date Issued <br />