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BUILDING PERMIT APPLICAYIOIt C?��;'"•7� ! r <br />Applicant To Complete This :orm <br />If pore than one building is to be contrucced, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. <br />f)mer (711ntnn E Cm•n. t! Building Address ,21 V A F, %.36�ST, <br />11Edresa ::^ Jnci;srn, Lot` Block ' <br />CityPhone n.5 Subdivision (Plat) <br />11rchiteat/Snglhebe ;!!ntgn <br />• +. °j� City Phone Metes i Bounds (Vnplatted) <br />:., •i Contractor 1°n1nr, ::nrhrll SeC. Tup. Rge <br />•' - <br />�. . c AddrC^5 .....n Im 1. nn <br />f. city Phone ^ Building Use. <br />t State License Number 1.+U -< - <br />Describe Work to Be Done'!; ` <br />r r Via•. k,nnsiruct!nn) <br />.1 Expiration Data <br />SKETCH PLOT PLAN BELOW <br />Use Of 8uildirig <br />(New ❑ Addition ❑ Repair/Remodel <br />,• �• Valuation of Construction — <br />A. <br />PLOT PLAN REQUIREMENTS <br />' Ipdicate lot size, name of streets, t <br />-indicate location and width of _ <br />; alleys, locate proposed and all <br />existing buildings, show distances <br />y +. to property lines, show distances <br />between buildings. <br />Lot size ^ x , <br />• • Lot area Sq. Ft. <br />:.i'! Size of BTTg.+ -t Sq. Ft. <br />r• Number of Stories _ <br />Basement <br />Signed By l <br />i. For <br />OWIIcr P one h• <br />DO NOT W31TE BELOW THIS LINE —FOR CITY USE ONL'1 <br />Date Received I� �? ,I Ute• 2ono <br />Plan Creek Number r F! ro Zone �3 <br />Occupancy Croup <br />Valuation <br />�•Z f, Type of Construction <br />Permit Fee , <br />Plan Check Pee zaZk Occupant Load to <br />Total Fee Due Sprinkiers Required 11 <br />Date Issued - c• <br />Id <br />