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BUILDING PERMIT APPLICATION r Q �•c <br />Applicant To Complete This Form <br />If more than one building is to be contructed, submit a separate permit a- <br />tion for e_alch huilding. A separate permit will be issued for each building. <br />I!1 U 0 Building AddressZ L11 2 % 3 XP <br />Address _ �: %% Lot_ Block <br />City ty E / ffT Phone Subdivision (Plat) <br />Architect/Engineer <br />City Phone Metes s Bounds (Unplatted) <br />Contractor A A !!5&JZ )(C& Sec. Twp. Rge <br />Address _ 1531.7-17) D`, (,jj <br />City A UJ0(330 Phone Building Use <br />State License timber 2Z 3 O/ 13 r'S-1 Describe Work to Be Done <br />Expiration Date //- / -7.S^ CS o2 THY <br />SKETCH PLOT PLAN BELOW <br />Use of Building <br />C1New ❑ Addition ❑ Repa•-i�r�/Remodel <br />Valuation of Construction $ .X?OCf, cl'3 <br />PLOT PLAN REQUIREMENTS <br />Indicate 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 B q, Ft. <br />••• Number of Stories S <br />Basement n <br />Signed By cl"., / 7— �jy.•�� <br />For <br />Owner Phone <br />DO NOT WRRITE BELOW THIS LINE -FOR CITY USE ONLY <br />Date ^aceived - 0 -VY ULe Zone <br />Plan Check. Number Fire Zone <br />Valuation 6� <br />Occupancy Group <br />Permit Fee <br />Type of Construction <br />Plan Check Fee Occupant Load . <br />Total Fee Due Sprinklers Required <br />Date Issued <br />