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• .. <br />, • DUILDING P13R17IT APPLICA�riota • 3.� �j - �,� . <br />• Applicant To CompJ.eL•e T.hi.s, Form ; �( � <br />°>�-2 3�i G . <br />If more tlian one building i,�to be constructed, suUmit a separ.�i:e per.mi.t <br />applic�;:i�n for each building. h sepsrat•e permit; wi.11 l�e i��ucd for. each <br />building. <br />Owner '�� � / � ! . ��, .- ` <br />vt i(�>.� IIuilding Addre�s �/S�r'.2r-,..;,rr,�,.,, <br />naar��s 1G.�.; �� �� ��f ,� �`'. .. r.ot nio��: � <br />City t, � � Phone��s/.,S-i�� SuUdivision (Plat-) • <br />Archi�ect/�ngineer �� �,,u � <br />City Phone Metes & IIound� (Unplatted) <br />Contrector u�,� ,�,_F � Sec.�_T�ap,�9 iL� Rge.�� f�ci��J <br />Addr4:s <br />City Phone • <br />Statc License tlumber 7.�3-0�- /c�Gds� <br />L>:piration Date .3 �;�- 76 <br />COl•P?.v"':' PLOT PLA17 ON REV�RSE SID� <br />, � <br />IIuilding Usc��Lwtz�,_���-„��,y� ,� <br />i <br />Des :ribe S•]or): to Be Done <br />• � . <br />.L: �7t r L�-�z1./_�P u-c�v%T. ' � cc. r �� <br />1�����-�J i/ w i� <br />Numher oi SL-ories � <br />Basement -� L�� <br />" " 2�ew Isddition �.Repai.r./Remodel' <br />�--- <br />Valuation of Con�t�uction $i�?S-c`O <br />� <br />Signed IIy , �_� �Y� �,� ,.� ; <br />For �c,c�at.-�, � . � i a,t . <br />Owner • Phone.�.9 S�Si�� <br />_ • Do t2ot i•7rite Be].ow Thi.c T.; i� •ror City Use Only <br />Datc fieceived � " " ' • � Use Sonc � <br />Iflan Chec): Number ' • Tirr. 2one <br />Valvatiwi ' • Occupancy•Group <br />Pernit Fee • . Type of Construci:ion _ <br />Plan CUeck I'ee ' Occupmit Load <br />Total I'ee Due Sprin)cicrs Required _ <br />Date Is�ued <br />