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BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />3/�01s <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 r6 Jo6n`ml <br />Address_�p3- <br />City_ _ t.uerc i Phono 3S""3-31c}!a- <br />Architect <br />City. Phone _ <br />Contractor­,ej <br />Address <br />City. Phone <br />State License Number' <br />Expiration Date <br />m <br />Building Address 7 <br />Lot I Blk. Sac. <br />Twp. Age. <br />Subdivision (Plat) 4011i C 1 e s+ <br />Metes & Bounds (Unplatted) <br />Building Use <br />Describe Work to Be Done EY cci- Fe n <br />Use of Building <br />'_ New ..Addition Repair/Remodel <br />Valuation of Construction $I� <br />PLOT PLAN <br />Indicate lot size, name of streets, <br />indicate location and width of <br />alloys, 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 S.F. <br />Size of g. S.F. <br />Number of Stor es <br />Basement <br />Use Zone <br />Signed By &rbartL j' <br />For <br />Owner <br />DO NOT WRITE BELOW THIS LINE -FOR CITY USE ONLY <br />Date Received Fire Zone <br />Plan Check Number. Typo of Construction <br />Valuation Occupancy Group <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Permit Number <br />Date Issued <br />Occupant Load <br />Sprinklers Required__ <br />APPROVED FOR 1UILDING PERMIT <br />