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BUILDING PERMIT APPLICATION <br /> Applicant To Complete This 7orm <br /> If more than one rilding is to he contructed, submit a separate permit app eiLa <br /> o <br /> tion forAcabuild'ng. se crate permit will be issued for each building, <br /> �l Building Address <br /> Owner 7CJ o- <br /> Address ��.•lei olo,/ Lot J �fJ.P.2�lO k <br /> City C-�LzC (� rhone 3�� '39 Subdivision (Plat) L/ <br /> Architect/Engineer <br /> amity nn Phone Metes 6 Bounds (Unplatted) <br /> [r {.C /'1-P/li Sec. Twp. Rge <br /> Contractor • <br /> Address <br /> City <br /> Phone Building Use <br /> State License Number Describe Work to Be Done <br /> Expiration Date <br /> SKETCH PLOT PLAN BELO14 <br /> Use of Building t <br /> LC*l , JoNew [I Addition ❑ Repair/RemodO <br /> l —� <br /> 1, Valuation of Construction $�_ <br /> g$ I V. <br /> PLOT PLAN REQUIREMENTS <br /> )� Indicate lot size, name of streets, <br /> indicate location and width of <br /> alleys, locate proposed and all <br /> i existing b-jildings, show distances <br /> to property lines, show distances <br /> 44 ` 0 ` d between buildings. <br /> V) Lot size �_x 4S D <br /> ' Lot area Sq. Ft. <br /> a <br /> Size of D TDX Sq. Ft. <br /> Number of Stories ` <br /> ?ascr.cnt <br /> ;.T 10 <br /> I <br /> Signed 9y � <br /> I <br /> li• ���'" For <br /> — Owner Phone <br /> vS'S 7y' pl &. <br /> DO NOT WRITE BELOW THIS LINE-FOR CITY USE ONLY <br /> rUe Zone <br /> lite Z c71�1(.i(3 T"aJ-A. i�(1R <br /> Fire Zone 3 <br /> .�ti M) occupancy Group <br /> Valuation f <br /> Type of Construction 1) tj <br /> Permit Fee <br /> Plan Check Fee ¢ occupant Load <br /> ?7�f't' Sprinklers Required <br /> Total Fee Due <br /> Date Issued t <br /> Iz�9-• -74 <br /> ( <br />