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<br />. , � DUILDING PCRI7IT ?�PPLICATION • ��%�' �lO � •
<br />� • AP�ilicant To Comp].etc 7:his. Porm ' 3�`% 3���/��
<br />If mo:e than one bui.ldinq i,�to be construct�cd, submit• a separ.aL•e per.mi.i:
<br />application for. each building. ]1 separai:e liei-mit �•ii.11 he ZSJUCCI fo�- eacli •
<br />buildinq.
<br />Owmer ��1�'C/'i== f✓OG'/ Uc�O IIuilclincj nddress /. �-� ��r>orr-ti� „��/
<br />Addi�ss � :; �i �i,�n � ��n�, ./--.., Lot /i I31oc1; �
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<br />City ����,:.,. � Phone Subclivision (Plat) �,,,,,,/,'- �C�;//r .
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<br />Architcct/Engincer �-"% rii ��T, vc�,�;�� ai /�i �-��.-i-%->- ��i �r '
<br />City �,�a„��,�y,� Phone ���.r-,.,CC-%� Metes &� IIounds (Unpleii-ted)
<br />Contr�ctor �i'�i✓-.�r2i���-,•�� i/v�yii �.Sec. Tivp. Rge.
<br />Addl�ss ��.,�� � ,%'2�c ,r
<br />City /-rr_�.vcT-� Phone :�:r�_ -.�,�r1 •
<br />State License humber a_. ��,,i P: �„�,. f� .
<br />Er.piration Date �`�°n�'�
<br />" /% - i; - �-'� •
<br />COI^F�,== PI,OP PLA2i Q� RFT7�RSE SID�
<br />Building Use �,Ei,�%� ��'z �'�
<br />Describe P:or}: to IIe Done
<br />� �»�n�x=- Gfi�''S /Sf'F/n�.- /�//F'iP,i..
<br />�ci/r✓ �✓�iv �'/�i+�� �o �+' ov�/.4� �
<br />Number of Stories �
<br />• Basemen{: c/%r
<br />' ' ' " Idet�r Addiiion .Rep�r./Re�el'
<br />. Valuation of Consi:ruction $ �/�OC7�
<br />5igned IIy � ! ��, )
<br />. . Fol i� r,��,�c� � C �i��
<br />.. v
<br />� Owner � Phone¢,,r-:,r�c�
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<br />• Do t.ot t?ritc IIelow This Linc -P'or City Use Only '
<br />Date Reccived 3�5�7� ' ' ' ' ' ' " -�� Use Sone ,�'�" G� L� . /. �/d��"
<br />. - �.r�,;�, <a�-��,
<br />ISl.an Caecl: Number 7Cs -/8 Z • Fir. t: 2one if� '1-•
<br />Valuation '%G%��f/� �'�' ' • Occupancy • Group � - z
<br />Pernit Fee �S�- �'� . Type oi Consi:ruction '
<br />Plan Check Fee "l-�� �' `, • Occupant Load
<br />Totzl Pec lluc 'J'G ��''! Sprinlcicrs Required
<br />Datc Issued �. • .
<br />• • CITY OF EVE
<br />RETT
<br />' � AP_PROVED• FOR BUILb6NG PERMIT
<br />. � iSate-:::./i � / -� �. Ry �--�
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