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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form d <br />If more than one building is to be constructed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />building. <br />Owner /�. A . f� /.i /�_ Building Address. ;z <br />Address Lot^/ Block <br />yy' <br />Phoney L.2 -/4-�'�Subdivision (Plat); f l05-PA4 <br />Architect/Engineer <br />City Phone Metes k Bounds (Unplatted) . <br />Contractor Al� /L" I,vST, Sec. Twp._Range <br />Address///i'4 - <br />Phoneq.:, = /4� Building Use <br />State. License Numyber+Q Y-,•/_ p/ Describe Work to be <br />Expiration Date y p/L _ X - 7/�- <br />SKETCH PLOT PLAN BELOW <br />Owner I T.1 <br />Voluction Permit <br />Plcn Ck_._--,. Paid — <br />10 [)Ye Carr. <br />ficuling P7o nd I ncq'A <br />1 or <br />~2 I`4II Ping <br />Pion Check No.�S— ��� -- <br />Set of^ - -- <br />•UseofBuilding /1,'•/ivit%l�7CL% <br />II New Q Addition Repair/Remodel <br />/ 3, 0CP0 19e7 <br />Valuation of Construction E / elga"Oej <br />PLOT PLAN REQUIREMENTS <br />Indicate lot size, name of streets, <br />indicate location and width of alleys, <br />locate proposed and all eristing <br />buildings, show distances to prop- <br />erty lines, show distances between <br />buildings. <br />Lot size(6'4t x <br />Lot area gS,Lj2 Sq. Ft. <br />Size of Bldg. / t /1 Sq. Ft. <br />Number of stories <br />Basement /ice <br />Signed ByXAz r^ Date4l-717-6— <br />For• LJ r0• <br />Owner Phons_91,5'.S - <br />DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY <br />Date Received 1- 7 - 7 -r Use Zone <br />Plan Check Number <br />Valuation / ;3,. DU <br />Permit Fee . O 0 <br />Plan Check Fee ' <br />Total Fee Due ' 0 <br />Date lssued <br />Fire Zone <br />Occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />