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- <br />BUILDING <br />PERMIT APPLICATION .f, <br />Ppplicant <br />To Complete This =orm <br />If more than <br />one building is to <br />be contructed, submit a separate permit applica- <br />tion for each <br />building. A separate <br />permit will be issued for each building. <br />Owner <br />Building Address <br />Address <br />Lot Block <br />City �� <br />Phone <br />SubdiVLsion (Plat) <br />Architect/Engineer <br />•`+ -_'i <br />City <br />Phone <br />Metes i Bounds (Unplatted) <br />Contractor <br />Sec. Twp. Rge <br />Address <br />' <br />i <br />City <br />Phone <br />Building Use "•;:' <br />rJ <br />State License <br />Number <br />Describe Work to Be Done _ <br />Expiration Date <br />SKETCH <br />PLOT PLAN BELOW'- <br />1 r <br />' <br />Ose of Building I 1 <br />a <br />[]New A Addition C3�Repair/iNMNEM4- <br />i <br />Valuation of Construction $ <br />PLOT PLAN REQUIRMIECITS <br />Di7 <br />b <br />cP <br />.. I <br />r <br />Ilidicate lot size, name of 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 "' x <br />. Lot area Sq. Ft. <br />Size of Bl-sg. Sq. Ft. <br />Number of Stories 7 <br />Basement I <br />_ <br />I ` , Signed By . C.. <br />I' For }41N6 Kobpv�- C. <br />.Qw4ler Phone <br />DO NOT WnITE BELOW THIS LINE-Fon CITY USE ONLY <br />Date Spceived ULe Zone <br />Plan C'neck Number Fire Zone <br />Valuation Occupancy Group <br />Permit Fee Type of Construction <br />Plan Check Fee Occupant Load <br />Total Fee Due Sprinklers Required <br />Date Issued - <br />