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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />if more than one building is to be contructed, submit a separate permit applica- <br />tion for each building. A separate permit will be issued for each building. <br />Owner CJi I EYI 5 X-STEYEA/SoN_ Building Address <br />Address 1 / Jy� S 7-Lot (off Block <br />City fwERr7-r Phone Subdivision (Plati �n�.�n0-t.•i�e�hn—n'-Q_ <br />Architect/Engineer <br />City Phone Metes a Bounds (Unplatted) <br />Contractor Fy£RETT /}rLc0£R5 <br />Sec. Twp. Rge <br />Address CGeG ALIEC69ErN i✓AY <br />City F,;ERETr Phone-JjL:Z(j Building Use <br />tow <br />State License Numberjt3J-oi-ACt"CA-AE43Ocribe Work to /Be Donee,,., <br />Expiration Date a / _ %%I <br />SKETCH PLOT PLAN BEL014 <br />Use of Building <br />DNew ❑ Addition O Repair/Remodel <br />Valuation of Construction — <br />PLOT PLAN REQUIREMENTS <br />• Indicate lot size, name of streets, <br />indicate location and width of <br />alleys, locate proposed and all <br />existing buildings,.show distances <br />to property lines, show distances <br />between buildings. <br />Lot size x — <br />Lot area Sq. Ft. <br />Size of B g. Sq. Ft. <br />Number of Star ees <br />�.• Basement <br />tr <br />- <br />Owner hone _ <br />DO NOT WRITE BELOW THIS LINE -FOR CITY USE ONLY <br />Date ^.cceived Z.S (�_ U:e Zone <br />Plan Check Number <br />Valuation <br />Permit Fee /• �� <br />Plan Checl. Fee <br />�7 oU <br />Total Fee Due _ <br />Date Issued ✓ �� i <br />Fire Zone <br />occupancy Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />CITY CF r. r--�Tr <br />APFrOVrF) I ( 1'ml lr <br />Date <br />I= <br />