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• — allILnlNc rEnmtT APPLICATION / <br /> r / + , <br /> Applicant To Complete Thin corm . , ' <br /> If more than one building is to he contructed, submit a separate permit applica- <br /> tion for each building. 1L separate permit will be Lusued for each building. <br /> Diners { i l ':= Building Address <br /> Address Block <br /> — ; Lot Block <br /> City 1 i; i ; _ Phone ` __'� Subdivision (Plat) <br /> Architect/Engineer <br /> _ •1 ".'J City ; 1 Phone Idetes a Hounds (Unplat-ted) <br /> o <br /> Contractor _iirec. Top. Rge <br /> j. . i _=rocs <br /> -.City .Phone 'Building Use <br /> 1 <br /> State,License Number Describe Work to Be Dune <br /> I Expiration Date )..111 YAC �- <br /> SIZETCU PLOT PLTdt BELOW <br /> J <br /> Use of Building <br /> �• i Mow Addition ❑Repair/RemoC:ol <br /> s <br /> i Valuation of Construction <br /> r.• + <br /> FR <br /> Iia , V!EW, 711LOT PLAN REQUIRr-MENTS <br /> j Indicate lot size, name of streets, <br /> ,Indicate location and width of <br /> r. • j' alleys, 'locate proposed and all <br /> existing buildings, sho:J distances <br /> y ? •. -• r- •a _ -.to property lines, show distances <br /> 1 b between buildings. <br /> Zot size Ix / C7 <br /> Lot area L9 Sq.Sq. Ft. <br /> Size of Meg: - Sq. £t. <br /> IJumbar of Stur,ics <br /> Basement _ <br /> Signed By <br /> l For <br /> -""`"'•'� Owner Phone <br /> Mr-LOW 79lTS LINA-FOR CITY USF. O1JL'L _ <br /> Date Received Uro. Zone <br /> Plan Cocc;; :Jur,bcr Fire' Zone <br /> Valuation Occupancy Group _ <br /> Pe3nit. Fee Typn of Construction <br /> Plan Check £ce _ Occupant Load <br /> Total I'ev. Due _ Spiinkldrs iAoquirerl <br /> Date Issued <br />