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J 6 �tfa <br />BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form /71 <br />if more than one building is•to be <br />constructed, submit a separate permit <br />application for each building. A separate per.ntit will be issued for each <br />building. <br />Owner Z' ( <br />Building Address '31' <br />Address i / �, / � ii �vu Lot Bloch <br />City jiCs PYf Phone ��h� / 7�Y <br />/ <br />Subdivision (Plat) <br />11 <br />Arehitect/Engineer <br />City Phone <br />Metes & Douncls (Unplattecl) <br />Contractor <br />Sec. Pap. Rgu. <br />Addr _Ss <br />_ <br />City Phone <br />State License Number <br />Expiration Date <br />Building Use <br />Describe Work to Be Done <br />� '- 18fOft �� <br />AhQ-COLT= <br />i' PLOT PLAN 014 REVERSE SIDE <br />Number of Stories _ <br />Basement <br />" New ' Addition Repair. rIcmode <br />Valuation of Construction $ OJ <br />Signed IIy .1 ._L*.' 21-1 . <br />/, . For <br />Owner Phone — r% <br />Do Not Write Belov., <br />This Line -For City Use Only <br />Date Received. 17 ! <br />Use Sonc <br />Man Check Number <br />Fire Zone <br />Valuation % �(Q. O a <br />Occupancy -Group <br />Permit Fee Fc� <br />Type of Construction <br />Plan Check Fee <br />Occupant Load <br />Total Fee Due U <br />Sprinklers Required <br />Date Issued f­,- <br />