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J �� �l / <br /> S BUILDING PPRMIT APPLICA'.�ION �� % j' <br /> Applicant To Complete 7'his lorm ,,?��y��� <br /> If more than on� building i.s to be constructed, submi.t a separate permit <br /> app].icati.on for each building. A s�parate permit wi11 be issued for eacli <br /> buildiny. <br /> I : � 8•I�-�% <br /> Owner � IIui.lding Address �-r--= <br /> Address i Lot �� / IIlocl: <br /> City _ Phone � � !, '; , Subdivision„(Plat) <br /> Architect/Pagineer '' � , <br /> ����c_•_t -:: _, ._.: , ` _ <br /> Cit}� Phone Metes �& IIounds (Unplat-ted) <br /> Cont?:actor. � ' Sec. Twp. R e. <br /> AGdress <br /> 9 <br /> - _ �t/cY �. �Z— <br /> City ; �, ii .. Phone ' <br /> AS M� A t_G �zy Mt�P_. trr� ST ep <br /> State License ]Jumber _ — • �� �� PA�A <br /> .:c ro 7,v /Jc c. /i.vc <br /> Lxpiration Date 'L`2�3-C�� - I IZ.'15 ' <br /> — Oi' Tts-r.,r anr. .- `}1L, Z (�jpJ <br /> C--�oeoE �� LiT^t�L1- 7)i..- '°L � �— <br /> � �,v er- Sr �-p IJ o ! <br /> Building Use <br /> ; � r �,w — <br /> >• ;„, Describe Tdork to IIe Done <br /> „t-,,:, � <br /> • ----- — <br /> �\ <br /> Number of Stories <br /> , Basement � <br /> New Addition Repa�r/P.emodel <br /> N`;k ,,^ Valuation of Corstrur,_.ion $ <br /> ^ ,�:: <br /> � ' Signed IIy <br /> For I — . <br /> Own�1 Phone <br /> _ Do �Tot t9rite Below This Line-I'cr City Us� Only <br /> llate Receiv�d _ ��3�jy� . Use Sone C—`� �Q,���f <br /> I�lan Check P;umber 7�,— /g� _ Pire Zone �� <br /> Valvation Occupancy Group <br /> Pennit I'ee <br /> — Type of Construction . <br /> Plan Check Fee Occupant I.oad <br /> Total I'ee Due __ Spr.�.nklers Required <br /> Date Issued <br /> � . ,�,,:_ <br /> x� <br />