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. 7,�� � . , . <br />. • DUIT,DIWG PIiRMIT APPLICATION • ' �-� Jl • <br />• npplicanL- To CompJ.ete 7'hi.. lorm '?C,,� <br />� � �� <br />zf more than one building i,� to Ue consl:ructed, suUmit A^Cp�17-AL•f/pfD'Sl ].l; <br />application for cacl� buildinq. A �eparate permit �ai.11 bc is�ucd for. cach <br />buildinq. / <br />OMmer µ 2 �.0 � �1 ' �--��-<<•-ri-�_ IIuilding nddress ,S'�� .t7'Ls-M/,<,,. <br />Address ��<�.� ; 3.�r � ='t',j� Lo1: 131oc): <br />City �� w z.. r t� Phone 33 •/-,5 ��S Subdivision (Plai:) • <br />Architect/�ngincer _�2-,-.�. <br />City Phone Mete� & Dow�ds (Unplr,ttecl) ` <br />Contrzct-or _��-o-,-,t.� Sec.�Ts.+p. �7 9 N' Rge. .5��'��� i <br />Addre->s <br />City Phonc • _ <br />State License t�umber „�,.�.3• ai - /c.�EY� <br />Er.pira �ion Date .3- � �- �� <br />� � IIuilding Usc %L�.�.C�(�,�a�-,,,.3`dri,�" <br />' Descr:.he t•:or1: to Be Done <br />� �n-CC*�a_'ri.•�v_ca�-�-,.� � aiLcc <br />CO]-L��."_' PLOT YLAIl 0?7 REY�RSE SID� GG;wz-Q �-,�G' <br />Numher of Stories � _ <br />. ' IIasemenL' iLo <br />• . ' ' " l�ew Addition �Ttepai,r./Remodcl� <br />� <br />� � . Valuation of Con�truction $/.�5��"- <br />. . , Signed IIy '� � t � a-f�- /n �, % <br />• . . For it.,�� J <br />� Owner • hone��3"iC� <br />�• Do t:ot T9ritc IIelo�v Thi� Line -I'or City llse Only � <br />Dai:.� Received ' ' ' ' ' • �� Use Sone ' • <br />1Tlan Chec1: Number ' • Tirc 2one <br />Valuation ' • Occupancy•Group <br />Pemit Fee � . Type of Co�isLrucL•ion " <br />Plan Cl�eck I'ee ' Occupant Load <br />Tot-al 1'ee Due Sprinlcicrs Required <br />Datc T�sued . <br />