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BUILDING PERMIT APPLICATION ., <br />Applicant To Complete This Form <br />If more than one building is to be constructed, submit a separate permit ap- <br />plication for each building. A separate permit will be issued for each build- <br />ing. <br />Owner PAV4- b'6R7"ALAA/ <br />Address <br />city& • r�t'Q* hone <br />Architect <br />City_ Phone <br />Contractor�1 �% <br />Address %Z3/99' <br />City 7PhoneA4?4..f <br />State License Number' "0/'S'r au-4-4 <br />Expiration Date ja-9r <br />Date Received allZ /7 Si <br />Plan Check Nu��m��b��e--,r,,.,,//� <br />Valuation1 �� <br />Permit Fee 3 U <br />Plan Chock Fee <br />Total Fee Duo ✓ z • OU <br />Permit Number (L-- - 7 6 <br />Date Issued <br />Building Address 1.1 <br />Lot Blk. Sec. <br />Twp. Rgo. <br />Subdivision (Plat) <br />Metes & bounds (Unplatted) <br />! lt+ <br />Building Use <br />Describe Work to Be Done <br />Use of <br />- Now Addition Repair/Renodel <br />Valuation of Construction $ ✓``O d <br />PLOT PLAN <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings, show distanzes <br />to property lines, show distances <br />between buildings. <br />Lot size X /,? I; -- <br />Lot area S.F. <br />Size of B . gS.F. <br />Number of stories <br />Basement <br />Use Zone <br />Signed ir�— <br />ro" <br />owner <br />Fire Zone S <br />Type of Construction V - t <br />occupancy Group I __ <br />occupant Load _- <br />sprinklers Required _ <br />APPROVED FOR DUILDING PERMIT <br />Wte`t-! I -L� - - I< . C_ . <br />