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f <br />� <br /> � /s_ �.� <br /> IIDILDING PERt+IIT APPLICATION ��3��.E <br /> Applicant To Complete T.his I'orm <br /> If more than one building is to be constructed, suhmit a separate permit <br /> application for each building. A separate permit will be issued for each <br /> building. <br /> Owner � �„ ,y. /� �,.�� IIuilding nddress � � Nr <br /> Address /� " Lot- ��/ IIlocl: � <br /> City � Ph ne Subdivision (Plat) �%l��'�,�'� <br /> Architect/�ngincer /�/�'� Ff(% <br /> City Phone Metes. & Bounds (Unp1aL-tcd) <br /> Contr.aci-or Sec. Twp. Rge. <br /> Address <br /> City Phone � <br /> State License Number <br /> Expiration Date ._ <br /> I/ , 9 ��%� L�� <br /> Buil.din llse 4 <br /> Describe Plor}: to I3e Done _��' <br /> T,L, � � ,.�"'�// ��' r:Z�� <br /> � �,� i:n'r �n��',r'r7' 1,�1/s� <br /> Number of SL-ories / <br /> T3asement /I� �>/�/c' <br /> hew Addition Repair/Remodel <br /> � Valuation of Construction $ QO G� <br /> !x� Signed IIy � .,¢ �. �✓l <br /> � For <br /> � -� � �- `` -- <br /> � � �--- Owner Phone <br /> "/ Do T.ot �9rite IIelota T)iis Line-ror City tJse Only _____ <br /> Date I:eceived • Use Sone <br /> I�lan Check Number Fise Zone <br /> Valuation Occupancy Group <br /> Permit I'ee � Type of Construction � <br /> Plan Clieck Pee Occupant Load <br /> Total Fee Due Sprinklcrs Requircd <br /> Datc Isstted <br /> i <br />