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- "T <br /> DdILDIt70 PERMIT APPLICATION « <br /> i P43plicant To Complete This :orm <br /> ' If pore 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 building. <br /> ' Omer �' % rzLr. Building Address , o <br /> • Address 4 �-� In �. Lot BlCck <br /> CityFS�iCacZ� Phone _ td 23 subdivision (Plat) <br /> ' architect/Engineer <br /> •.'6• °.'� City Pl,onc Metes & Bounds (Unplatted) <br /> ContractorSec. Twp. Itge <br /> .lddress <br /> i -city Phone _ Duilding use " •{_... .. <br /> State License Number _ Describe Work to Be Done 720_ -U'- <br /> Expiration Data <br /> ti17 '� SrETC11 PLOT PLAN BELOW <br /> ' Ilse of Building <br /> ❑llew ❑ Addition Repair/Remodel <br /> i' C d_ <br /> '• I. Valuation of Construction S_6_00 <br /> :,PIAT PLAN nEQUIREMMTS S <br /> Indicate lot size, name of streets, F <br /> ' •indicate location and width of <br /> alleys, -locate proposed and all <br /> i• existing buildings, show distances <br /> t.r ,;�.. -• r- .^''i -to property lines, show distances <br /> t = A between buildings. <br /> Lot size x <br /> .-l•. Lot arca Sq. Ft. <br /> Size ofA g. Sc. Ft. <br /> r' Number of Stnr es <br /> easement <br /> A. _ <br /> ,. Signed Aym.1/u� <br /> — <br /> Owner Phone <br /> DO NOT li;tlTE BELOW THIS LINE-FOR C7TY USE ONLY <br /> Date Received 2- Uro—Zone <br /> Plan Check Nunber Fire Zone <br /> Valuation �iZXJ• �� Occupancy Group <br /> G <br /> Finait Fee 'S. Typo of Construction <br /> Plnn Check Fee Occupant Load <br /> olC- <br /> 9otal Fee nuc S Sprinl:L. rs RcguJ.rad _ <br /> Pate Issued y S/ •• <br />