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i <br /> - a� � �� ; <br /> IIUILDING PERMIT APPLSCATION ��S . <br /> Applicant To Complete This Form �:�5/7� � <br /> IL- mose than one building is to be constructed, submit a separat� permit i <br /> applicaL-ion Lor each building. A separate permit will bc issued for each ' <br /> buildinq. <br /> O�aner �r���,�f� lF1iC.�Lu .vJ IIuildin9 Address�-5(j� �GC +.�'� <br /> Address �,�.,/ ,aF-c� Lot �� �3a Bloc}: �� / <br /> City �vr;eF%T Phone �,�-��� Subdiyision (Plat) <br /> Architect/�ngineer �K�y�eS � s- 9G�� <br /> � <br /> City Phone Met-es & Bounds (Unplatted) <br /> Centractor ,jyq,.�� Sec. T�ap. Rge. <br /> Address <br /> City Phone <br /> State License NumUer ��3. �„ -��y�� <br /> Er.piration Date <br /> 13uilding Use {CE �,eF,+.� F7,r,��o,e <br /> Describe f?orY, to IIe Done <br /> C�71Si.U£T'S f ��r�r.C/- rr vF[Y^1' <br /> , � <br /> Number of Stories <br /> 13asement <br /> New Addition ;.epair/Remodel, <br /> Valuatio� of Construction $ <br /> J��} �� <br /> Signed IIy <br /> Por � <br /> Owner Phone <br />' _ Do Not Write IIelow This Line-I'or CiL-y Use Only <br /> bate Received 3 • Use Sone <br /> LTlan Check Number 7(0—/3 Z I'ire Zone z <br /> Valuatiou �Q(�. p� Occupancy GrouP F—z <br /> Permit Pee 7J�j, �U Type of Construction � <br /> �� ' Plan Check Fee �,�� �i D Occupant Load <br />` ,w <br /> i�� � . Total I�'ee Due Sprinklcrs Req��ir.ed <br /> � . Datc Issued <br /> � <br />� ."` . rrr; c i.�.��_�;c;r <br /> '?��°I APPROVED FQR 6UILDING PERMIT� <br />�' �'i <br /> ' �'�'r Date_Z/4 /�., B <br /> y 1�. G <br /> . A <br />