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Y) <br />BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more t)-in one building is to be contracted, submit a separa^e pexmi! applies-. <br />Lion for each building. IA separate permit will be issued for each builu:ing• <br />C6aer (Ai Building Address y }; o { ( <br />►Adress 21 y— 110 /•q P1 S F Lot Block _y <br />City = r e _ Phone 3 SS O3FsSubdivision (Plat) _-{ 11 4 <br />Architect/Engineer Srr•r4r"" Pr1 C4#:c,_ 00/ /Cp 1�4z�e Oro, c/s� YnoCO <br />City S'.7 04• Phone Metes i Bounds (Unplatted) <br />Contractor Liy, s{YPr.•1 Sec. Twp. Rge <br />Address 21 S 1 I u I l P1. 90 <br />City r ti Phone 3 J 5-03rt Building Use M& S <br />State License Number L/^/yp•ch•yg3�gk Describe Work to Be cone <br />Expiration Date <br />/ 2- 0 S— 7 G <br />' <br />SKETCH PLOT PLA11 BELOW <br />- <br />\ <br />Use of Building 2C .3 <br />m6w ❑ Addition ❑ Repair/Remodel <br />Valuation of Construction <br />Ste' PLOT PLAN REQUIREMENTS <br />(� <br />Indicate lot size, name of streets, <br />indicate location and width of <br />lleys, locate proposed and all <br />existing buildings, show distances <br />to property lines, show distances <br />h <br />L <br />between buildings. <br />W <br />Lot size <br />26 <br />r•• <br />i4 <br />Lot area /2 6, 0o Sq. Ft. <br />Size <br />of Bldg <br />g. Sq. Ft. <br />Number of Stories <br />1 <br />Basement' <br />Signed By <br />%0 <br />For <br />Owner Phone ' p <br />DO //NOT 101TL BELOW THIS LINE -FOR CITY USE ONLY <br />Date Received /��/� Uce Zone <br />Plan Caeck Number Fire Zone <br />Valuation ` b-0 Occupancy Group <br />Permit Fee / k/ ?�� Type of Construction _ <br />Plan Check Fee 90.5fl Occupant Load <br />Total Fee Due <br />Data Issued <br />Sprinklers Required <br />