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•; ' <br />j <br />BUILDING PERHIT <br />APPLICATIONaJ�r'��, • ,� v <br />• I <br />Applicant To Complete <br />This Yorm <br />it more than one building is to be conLLucted, <br />submit a separate permit ap ica 6 <br />,•: <br />lion for each building. A separate permit <br />will be issued for each building. <br />deer t�o%, i� crN/'iJ <br />Building Address <br />• <br />address - 2 N ST!^�°eT _ <br />Lot �i �� 3 Block <br />• <br />.• n <br />City At�der"7 Phone 3 SS -8SJ2 Subdi%rision (Plat) As P/„e hurS it,� <br />• <br />Architect/Engineer <br />' <br />city Phone <br />Metes i Bounds (Unplatted) <br />Contractor } <br />Sec. Twp.' Rge <br />Address <br />'f <br />City Phone <br />Bn44ding-Vee F a ecn Y <br />ii <br />State <br />Describe Work to Be Done �PHCe 9ir� <br />License Number <br />• ' : . Y <br />Hcplration Data <br />' J 0 r LA1J 1'n C�t aid �ir,� FP•,�, <br />SKETCH PLOT PLAN BELOW <br />.a <br />Use of.Buildifig _ <br />Addition ❑ Repair/Remodel <br />' <br />' �'�. <br />-=- —�-•y• <br />:New <br />$ 00� 0 �'e <br />o'naiValuation of Construction $ A <br />PLOT PLAN REQUIREFIENTS '3+ <br />---+ate'—` �'�/ ' • <br />Indicate lot size, name of streets, <br />indicate location :nd width of <br />locate and all <br />i�jn[L <br />�Gq!�.' <br />;+•: • <br />alleys, proposed <br />i• <br />�- <br />existing buildings, show distances <br />;�,'-•. <br />'r: <br />to propdrty lines, show distances <br />between buildings. <br />' �f •, <br />LJ• �` , Cg <br />Lot size %S j x % 3 <br />. Lot area Sq. Ft. <br />Size of BTcTg. Sq. Ft. <br />Number of Stories <br />f}� <br />i <br />Basement <br />Signed By <br />For l/a!/n g rfi4 Ton <br />7 Phone 3 <br />,• <br />owner .5 <br />DO NOT WaITE nELOW THIS <br />LINE -FOR CITY USE ONLY <br />Date Received <br />Uta-Zone <br />Plan Check Number <br />Fire Zone S ' <br />Valuation <br />Occupancy Group l <br />Pewit Fee <br />Typo of Construction i1 1�• <br />Plan Check Fee <br />Occupant Load <br />Total Fee Due <br />Sprinklers Required <br />Date Issued <br />- <br />