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-BUILDING PERMIT APPLIC"".•ION i <br />Applicant Complete This. Sorm <br />If more than one building is to be rontructed, submit a separate permit applies n// <br />tion for each building. A separate permit will be iasued for .!ach building. <br />Owner •'� � � Building Address — <br />Address _/' Lot I' Block <br />City Phone Subdivision (Plat) <br />Ischitect/Engineer <br />City Phone Metes i Bounds (Unplatted) <br />Contractor See. <br />Twp. Aqe <br />Address <br />City Z L L Phone Building Use 11 <br />State License Number Q-2 1 / Describe wark to Be Done Z <br />Expiration Date <br />SKETCH PLOT PLAN BE., 114 <br />DO NOT W11TG BELOW THI <br />Date Rc!ceived -7 ..,;) <br />Plan Check Number = ' 4-(( <br />Valuation (—Ccccm, Fes' <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Date Issued <br />Use of Building j <br />New ❑ Addition ❑ Repair/Remo-'el <br />Valuation of Construction $ 3C,"e(f <br />PLOT PLAN REQUIRL%1ENTS ? <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 />to property lines, show distances <br />between buildings. <br />Lot size x <br />Lot area Sq. Ft. <br />Size of Bldg. �^ Sq. Ft. <br />Number of Stories <br />Basement <br />Signed By <br />For <br />Owner Phone <br />ULe Zone <br />Fire zone <br />Occupancy Group <br />Type of Construction _ i• <br />Occupant Load <br />Sprinklers Required <br />• CITY OF EVFr�,; f 7 <br />APPROvbo F'OR 13lJILGI,VG PERMIT <br />By <br />