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BUILDING PERMIT APPLICATION / ,�� 6/•� <br /> Applicant To Complete This corm <br /> If more than one building is to be contructed, submit a separate permit applic <br /> tion for each building. Asseparatc permit will be issued for each building. <br /> Owner wl 4( 1p /lnTO <br /> / /lan Building Address 3/ ��- �G fil SLtlf <br /> Address A72,5190 sr SW Lot_�2 Block <br /> City �f ,e Phone 2,522517-2 / Subdivision (Plat) ' <br /> Architect/Engineer Cll vf- CA�it�tGL <br /> CityPhone // Met^s 6 Bounds (Unplatted) _ <br /> Contractor1111'� .'L _r/ �d EiPS Sec.__ Twp. Rge _ <br /> Address .471 !-76,L — <br /> City : ',.�.jT—Phone " s Building UseSLNGLEFAMr(7V /1�Ej/UF�LCr <br /> State License Number ZZ j- Cil^ y O Describe Work to Be Done <br /> Expiration Date <br /> SKETCH PLOT PLAN BELOW' ' <br /> Use of Building <br /> 4New ❑ Addition ❑ Repair/Remodel <br /> Valuation of Construction $ <br /> - �tP PLOT PLAN REQUIREMENTS <br /> Indicate lot size, name of streets, <br /> p cs;7�1 indicate location and width of <br /> alleys, locate proposed and all <br /> existing buildings, show distances <br /> O� to property lines, show distances <br /> between buildings. <br /> o' '�• Gr.JG .;2" Lot size _ 5 _x l if- <br /> •- —� Lot area �2 DC7 Sq. Ft. <br /> Size of B13g. Sq. Ft. <br /> _ Number of Stories fly / <br /> 4 Basement <br /> o igncd By <br /> I. <br /> Y Owner P one <br /> ro ::0'. £SLOW THIS LINE-FOR CITY USE ONLY <br /> Date ?received �o� �- r� ULe Zone _— <br /> Plan Check :unber Fire Zone - <br /> Valuation Occupancy Group <br /> Permit Fee Type of Construction <br /> Plan Check Fee Occupant Load <br /> Total Fee Due Sprinklers Required _ <br /> Date Issued _ <br />