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�y` D <br /> BIIILUING 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. _ , ) 5T57x*Owner <br /> Address Building Addreast`may I h 7 6 <br /> Lot - Dlk. Sec. <br /> O , <br /> City C L,*_CL . phone S'- b�" °' 71�P• Rge. <br /> Architect Subdivision (Plat) <br /> City �_7_ P,hhone Me <br /> /1t <br /> es & Bounds (Urplattcd)�_ <br /> ' Contractor a y , - eft'+ -, its �r <br /> Address <br /> City• ' Phone 3 1- a7.S3 Buildirg Used / <br /> State License Number 973 -61=16-80 L Describe Work to Be DoneIlt.�,v- <br /> Expiration Date 7.(v <br /> Use of Building_-2�a��jo-�' <br /> New Addition Repair/Remodel <br /> ►►A(n��\\ Valuation of Construction $ CICIO <br /> PLOT PLAN <br /> ID ;I <br /> Indicate lot size, name of streets, <br /> indicate location and width o.`. j <br /> / e alleys, locate proposed and all <br /> existing buildings, show distan:es <br /> \y to property lines, show distancez <br /> I ( between buildings. <br /> I I <br /> Lot size xC1 <br /> Lot area- -- <br /> F. <br /> size of U gor. S.F. <br /> Number of Stes <br /> Basement <br /> Una Zone_ <br /> ISigned Dyes <br /> For <br /> Owner <br /> DO NOT WRITE BELOW THIS LINE-FOR CITY USE ONLY <br /> Date.•keceived 'vQ7!5 - Fire Zone h 1 <br /> Plan Check Number . W Type of Cons tru:.tion Q-l.l. <br /> Valuatl:ion v Occupancy Group _Z_ <br /> Permit. Foe <br /> lie�7 - Q'= Occupant Load <br /> �+ <br /> Plnn Check Fee S7P- Sprinklers Roquired <br /> Total Pea Duo <br /> Permit Number <br /> Date Issued _ <br /> APPAIEO FOR BUILDING PERM T <br /> Date t1 73 By <br /> M <br />