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- • 1 BUILDING PERMIT APPLICATION ,J••. i <br />( ,Applicant To Complete This Form <br />If tore thin one building is to be contructed, submit a separate permit applica- <br />tlon for each building. A separate permit will be issued for each building. 4 <br />Diener Building Address <br />Address ) c:// _ 11 Lot ] Block <br />City `� Phone jr Subdivision (Plat)/al•�pi�-3 <br />' Architect/Engineer <br />• ` .`_'' city Phone Metes i Bounds (Unplatted) <br />Contractor Sec. Twp. Rge <br />,! Address <br />1 city Phone Ruilding Use •; ;•�' ,, <br />y State. License Number Describe Work to Be Done Z <br />�I Lipiration Date /.i'I <br />jI SIOi'1'CR PLOT PLAN BELOW' <br />• J 1 .. • i <br />IIte of Building <br />a 13New ❑ Addition 0 Repair/Remodel <br />Valuation of construction 5 L' <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 />1 , r•,� .~'j _ to property lines, show distances <br />! 3 e between buildings. <br />Date Received <br />Plan.Check Number—T��-/'�/�� <br />Valuation��— <br />?emit Fee ! <br />Plan Check Fee r <br />Total gee Due 3 UL <br />Date Issued j <br />,l <br />Lot size x <br />Lot area sq. Ft. <br />Size of Bldg. Sq. Ft. <br />Bumber of Storzes <br />Basement <br />Signed By <br />For <br />Owner Phone <br />Ute Zone <br />Fire Zone <br />Occupancy Group <br />'type of Construction <br />Occupant Load <br />Sprinklers Required _ <br />