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BUILDING PERMIT APPLICATION <br /> Applicant To Complete This ^orm (�/ .j/�/ <br /> If more than one building is to be contructed, submit a separate permit appliceal///7 <br /> tion for each building. A separate permit will be issued for each building. <br /> Owner e/ -4W 7�7r, Building Address /-e) s S� <br /> Address Lot ' - Fni r N4`Block <br /> O p c-.' S <br /> City Phone / Subdivision (Plat) Seo• 44,Vh� <br /> Architect/Engineer <br /> City � r - Phone 'SSS -c_• Metes c bounds (Unplatted) <br /> Contractor ; ,-f 14{ Sec._ Twp. Rge <br /> Address <br /> City Phone Buildicc, Used F CL /Ade"9 ,i. '. <br /> i State License Number -2 ?'7C Describe Work to Be Done <br /> T <br /> -I Expiration Date N _cam✓ C, C-.*- -f�*1-•• ��,_ <br /> •� ' SKETCH PLOY PLAN BELOW <br /> Use <br /> of 3uilding 41 <br /> 01few O Addition ❑ Repair/Remodel <br /> Valuation of Construction $ <br /> t — <br /> �,,,. PLOT PLAN REQUIREMENTS <br /> Indicate lot size, name of streets, <br /> indicate location and width of <br /> alleys, locate proposed and all <br /> existirg buildings, show dist_nces <br /> 5 _ a to pror.-rty lines, show distances <br /> na betwee,! buildings. <br /> nac �a` Lot size 7 x / 2 <br /> C Lot area Sq. Ft. <br /> Size of SM. Sq. Ft. <br /> • ; Number of Stones <br /> Basement <br /> . '� Signed By <br /> For <br /> G mer Phone <br /> DO NOT WRITE BELOW THIS LINE-FOR CITY USE ONLY <br /> Date Received 3 Z S Uce Zone <br /> Plan Check Nur.•ber 7 S- 17 E�-j Fire Zone <br /> Valuation Occupancy Group <br /> Pemit Fee Type of Construction <br /> Plan Check Fee Occupant Load <br /> Total Fee Due Sprinklers Required <br /> Date Issued <br /> i <br />