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_ . <br /> . • DUILDIhG PERMST nPPLICATION • . �y��-�'� � . <br /> • Applicant To CompJ.eLe 7'his rorm • 3�� <br /> /�.1� <br /> Zf m�:e than one bvilding is� to Ue construcicd , submit• a .^>epar.�t�: per.mi.t � <br /> appYic�tion for. cacl� huilding. n �eparate pc�-mit �•�i.11 he is�ucd for. cach • <br /> building. � <br /> �� Oymcr ! �r'-v!ti +_ _- IIuilding Address �� Z (� <br /> naar��s� ,Sr` �� ,�,,,._�.� r.ot niooi: <br /> City .�,ca7�/,C, Phone Subdiyision (Plat) • I <br /> Archi:cct/Engincer � <br /> City Phone Metes & IIound� (Unplattecl) <br /> Contr�ctor C�/IQuJ l�//�dG . Sec. �t,rp• _ Rq�, �I <br /> Addre- g5do ���,�_�-� ,R �`Yln <br /> city �y//..�� Phonc SZS- �is� . <br /> State License llumber � <br /> Er.pirztion Date <br /> • . ' I <br /> ' Buildi�zg Usc _ u <br /> Uescri.be S•;or}: to Be Done ��-j�,,,� <br /> �% <br /> CO7-F'�_"^ PLOi PLI,2I 0:� R��RSE SID� <br /> � Number of Stories <br /> _ , • � IIasement <br /> � • " " l�er� Addition Repair./Rer.iadel' <br /> • V� ation of Const�uction $ <br /> ' . . �/ S� <br /> �v <br /> . , Signed �y C � . � <br /> � For ,ti; �-.-, � S�u- '��"-1' <br /> Owner rhone �ZS-Sis� <br /> _ • • Do fiot i•7rite Delow Thic Linc -Por City Use Only <br /> Date S:eccived " �� "' ' ' ' ' ' � � Use Sonc /�' — '' • <br /> IS]anC:�ec): Number4 ' • Firc 2one �`J / <br /> Valuation �� �� 5 �'. ' • Occupancy •Group <br /> Peznit Fee �U � Type of Conctruction ' <br /> Plan Check I'ce ' � � Occupant Load <br /> Total 1'ce Uue �,r-' ` - spri»lcicrs Required <br /> Datc I�sued � %'- �. . <br /> . .;" — . • <br /> . <br /> � <br />