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. • ���. � �'�, � • <br /> � IIUILDING P13RMIT APPLICAfION • _, ` �J • <br /> • ,hpplicant To Comp].etc Thi.s, ror.m ' _�,�./� , <br /> IL more than one bui.].ding i,� to be consL-ructed , submit a separ.ate permi.t <br /> appli.c�t•ion Lor. cach Uuilding. A scparale C�cr�niL aii.l.l be is�iicd for. cach <br /> Uuildinq. <br /> � Owner ���r[yi'�r �! (OMMJflITV n ���.r�h IIui.lding Address9`/o� ��;-.,,� �� i��. <br /> , , — , <br /> Address ]�/'✓c: 0�,�,,,,,;� L / Lol r:^ .S T31ocl: oa o ,L_0 1 <br /> = Subc'.ivision (P1aL-) �� , <br /> City 4.�err7T Pl�onc ,�S �= ;� _ < <�rrCv' o��r.� <br /> Archi`,.cct/Engineer 1�� �✓ <br /> City Phone Mete� & IIounds (Unplatted) <br /> ConErecL-or „�r✓n,f— Sec. Tc��p. Rge. <br /> Addr�.ss ._ <br /> City Phonc __ <br /> Statc License Number <br /> Er.piration Date <br /> IIuilding Use _i�a :'�qe <br /> DescriUe F;or1: co Be Done <br /> CO]•P"s�""_' PI,OT PLA11 OP� 1t�VGI,'SE SID� <br /> Number of Si:ories <br /> . Basement <br /> � " Idew Addition Repai,r./Rer,iodel' <br /> Valuation of Construction $ /�So� <br /> . • . �Signed IIy ��"';�c;�e�' '.� c n.�-��. <br /> . . � <br /> � � - � �� <�r i <br /> For J�::,.r.. �,Dv� : �_r_�=�i7 '��_� <br /> � Oivner Pho�ie ��_° % - ' � <br /> • Do 1'ot P;riL-e lle].ow This Linc -I'or. Ci.ty Use Only <br /> Datc Received ' ' ' • Use Swic _ <br /> IS1an C;�ecl: NumUer ' rirc 7,onc ,� <br /> Valuation � �Z9t� ' • Occupancy •Grottp � <br /> Pernit Fee � �`� � ��U Typc of Co�t.;t:1"l1C{:1011 �- t�] � � <br /> Plan Check Fee 7- S � Occupant Load <br /> Total Fee lluc .��-' Sprinlcicrs Requir.cd <br /> Dalc Issucd <br /> • c' I_„_: 11 <br /> ' � F,i'NI�OVcD 1=0�� GI�ILDING PERMIT <br /> . ' • � e �"=�_ <br /> ' . n�te Z �L�—��-v-Y—gy <br /> ti <br />