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.' <br />BUILDING PERMIT APPLICATION <br />�� <br />Applicant To Complete This Form 47 o <br />If <br />more than one building <br />tion for <br />is to be contracted, submit a separate permit a p ea- <br />each building. <br />A separate building. <br />p permit will be issued for each building. <br />/ <br />Omer <br />'gI• <br />1 <br />Building Address <br />o <br />Address <br />1 Lot Block <br />7�L� <br />City ovt <br />Phone 3J - Y4`u Subdivision (Plat) <br />Architect/Engineer <br />_ <br />i City <br />Phone Metes G Bounds (Unplatted) <br />Contractor <br />,r.•_�f Sec. 'lwp• RQe <br />Address <br />, <br />City <br />Phone Building Use <br />`j <br />— •:'•. <br />State License Number Describe Work too Be Done Ace. <br />• <br />I Expiration Data <br />• �`: <br />SKETCH PLOT <br />PLAN BELOW' - <br />j <br />( <br />i <br />Use of Building <br />QNew ❑ Addition ❑ Repair/Remodel <br />,Valuation <br />of Construction <br />PLOT PLAN REQUIMIENTS • ) <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />f_ <br />existing buildings, show distances <br />to property lines, show distances <br />a <br />between buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />t e.• <br />Size of Bldg. Sq. Ft. <br />Number of Stories <br />'1 <br />Basement <br />Signed By / CL-�•..,.y- <br />For <br />Owi,er P one <br />Date Received <br />�. <br />Uce Zone <br />Plan Check :lumber <br />Fire Zone <br />Valuation <br />OC--' <br />Occupancy Group <br />Permit Fee <br />!j G <br />Type of Construction <br />Plan Check Fee <br />Occupant Load <br />Total Fee Due <br />�t <br />Sprinklers Required <br />Date Issued <br />/ <br />