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��/� - �,� <br /> BUILDING PES2MIT APPLICATI�.:A7 �� � <br /> i/���lE <br /> Applicant To Compl.ete This Form <br /> If more tlian one building is to be constructed, submit a separate permit <br /> applicat,i-an�for each building. A separate permit will be issued for eacli <br /> buildin� � , <br /> Owner � � � IIuilding Address / ��O�' <br /> nddress Z o �j Lot��iLic.vi) /� T31oc1i-� � '� 7 ; <br /> City � l�P _ Phone - Su[lutivision �(Pl�at) �i�� <br /> Architect/�ngineer. �— (,/�+tP�7�T <br /> City Phone t•7etes & Bounds (Unplatted) <br /> Contraci:or �!�" l� / y� Sec. 'hap. _ Rge. <br /> Address �V � E' Y �� _ <br /> � • <br /> City _��/ re Phone�_3 _233/ <br /> State I,icense Numher�t3- o/-So- <'-tfS <br /> Expiration Date Q_ -�� z P <br /> / " r-�-- <br /> IIuil.ding Use i �V i <br /> �cr/ibe Work to Be Done — <br /> P!/L' C� cSB r/P ��`c..�!v q o�t <br /> � <br /> 7-���� V � s /�('g _ <br /> Number of Stories <br /> IIasement <br /> New Addition Repair/Remodel� <br /> Valuation of Construction S/SDa `�'" <br /> � � <br /> :-� �,�., , <br /> Signed By i��' ' ,���= - l. <br /> F'or ��'F, . � ��=G� ��r',s <br /> ��'�`::I Owner Phone3 i� 'f jj,3 � <br /> Do Not S9rite IIelow This Linc-For City Usc Only <br /> Date Receive3 Use Sone __ <br /> L�lan Chec}: Num»er rire 'Lone _ _ <br /> Valuation Occupancy Group _ <br /> Permit ree Type of Construction __ <br /> Plan Check Fee Occupant Load <br /> Total Pee D+.ie Sprinlclers Reqvired _ <br /> ' Date Issucd <br /> 4 <br /> .. �.. °.�. .,. . . � - r' <br />` <br /> I, <br /> 1 <br />�� <br />