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DUILDING PERMIT APPLICA'PION <br />�� <br />APB licant• To Compl.etc This Form <br />If more than one building <br />application for each <br />is'to be <br />building. A <br />constructed, submit <br />a separ�tc Pe �n;t�� <br />building. <br />separate <br />permit. will <br />be issued for. each <br />Owner " ' <br />Building Address r7� <br />Address a <br />�� • 7 <br />S"G✓ <br />Lot <br />Lsl��saTvr� <br />city !/Eh�E7T <br />Phone 35:3-,Fo <br />_� <br />Bloc <br />( k ?o? A of <br />Subdivision (Plat) <br />Architect/Engineer <br />City <br />Contractor <br />Phone <br />Metes •& Bounds <br />(UnPlatted) <br />Address <br />Sec. <br />Rge• <br />City <br />Phone <br />State License Number <br />Expiration Date <br />Building Use �• ; � <br />Describe Work to Be Done <br />C01Tb"7 PLOT PLAN 0)) REVERSE. SIDE <br />Number of Stories <br />Basement <br />New Addition Repair./Remodel' <br />Valuation of Construction 0 <br />av- <br />Signed By <br />For <br />Owner Phone 3S -/s-L¢ <br />Do Not Writc Below This Linc-Fob Uso* Only <br />Date Received Use Sone <br />1slan Ctec)c Number Fir(,- zone _ <br />Valuation Occupancy -Group <br />Pewit Fee <br />Type of Construction <br />Plan Check Fee Occupant Load <br />Total Fee Due <br />Sprinklers Required <br />Date Issued <br />