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_, o: 9 ` �� <br />IIUILDING PERMIT APPLICATION �� 3 d <br />Applicant To Complete T.his Form � ����,/7� <br />If more than one building is�to be constructed, submit ei separate permit <br />application for each building. l� separate permit will be issued for each <br />bui.lding. <br />Oancr �� / �- IIuildiny Address `",�� � -�,+.�,l�� `� � <br />Address �y�% �11 �'"/ � Lot IIlock <br />- ��%� SnUdivision iPlat) <br />City ��J�P2G� Pl�one��,-: �%a <br />Architect/Engineer <br />City _ Phone Dletes [. Bounds (Unplatted) _ <br />Contractor. Sec. T�ap. Rge. <br />nddress <br />Cit.y __ Phone <br />State Li�ense Number _. <br />T�:piration Date <br />�9rite IIelow This <br />Date Received /�Z��7 (o ' <br />i�lan Check Numbe� "�— ' <br />Valuation / ?C'� • � <br />Permit I'ee � • ��"� <br />.__--- <br />Plan Check Fee <br />Total I'ee Due � Py �` <br />Dat•e Issued /��� % �7 4� <br />IIuilding Use _ _ <br />Describe Ror}: to IIe Don._ � <br />i / �!% / �`',•Z �" �'; ::' /iG�iGv <br />i �/ � .�� ���/7 . <br />Number o Stories <br />Basement <br />New Additioi. Repai.r/Remodel <br />�• ,., <br />Valuation of Consiruction $ /UL�� —" <br />Signed By � ,;�,���� <br />ror <br />Owner Phone <br />Citv iJse 0 <br />Use Sone <br />I'ire Zone _ <br />Occupancy•Group _ <br />Type af Con�iruction <br />Or.cupant Load <br />Spri.nlc:lers Rec�uir.ed <br />e <br />