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r <br />BUILDING PERMIT APPLICATION <br />Applicant To Complete This Torm <br />If more than one building is to be contructed, submit a separate permit applica- <br />tion for eaen buirrlding. A separate permit will be issued for each building. <br />Owner nBuilding Address 17e 7 <br />orn-c.i�Yr <br />Address/7o y - �'U Si i Lot Block <br />City f,,.c_ R�_ Phone.Q SS Of S/ Subdivision (Plat) % i _1 <br />Architect/Enginec. _ <br />City E VEREi y Phone Metes a Bounds (Onplatted) <br />Contractor — ,L F _ Sec. Twp. Rge <br />Address <br />City Phone <br />State License Number — <br />Expiration Date <br />SKETCH PLGT PLAN BELOW <br />iu' <br />Date ^eceived //_—(,;<_� <br />Plan Check Number <br />Valuation <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Date Issued <br />Building Use ' <br />Describe Work ­;to <br />y� <br />to Be Done leg_ <br />A A C6£ � RXI 10 covew— <br />Use of Building TTT <br />[]New Addition E3Repair/Remodel <br />�^ <br />Valuation of Construction $ <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name if 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 (�O _r JIILO <br />Lot area Sq. Ft. <br />Size of B gg . Sq. Ft. <br />Number of Ster as <br />Basement �9 <br />Signed Byi- <br />For <br />Owner P one <br />'INE-FOR CITY USE ONLY <br />/ U.e Zone 127V 7/ - <br />Fire Zone ✓. <br />Occupancy Group <br />Type of Construction J• 1� <br />Occupant Load. <br />Sprinklers Required tj 0 — <br />@PP <br />