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i <br />BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more than one building is to be <br />constructed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />building. <br />Owner FLUE M Fd, ('O_ <br />Building Address jp2_ e EVezerff vo'y <br />Address `f O 2 E'V c r2 cl R Er. m 100,!4 <br />Lot S-(o Block <br />City EVERE-r-T Phone 774-:23,6 <br />Subdivision (Plat) Y <br />Architect/Engineer E , 7,'q <br />Cgi!, <br />.1, <br />: �u mt�'c-S <br />City Ss,4-rTcr__ Phone AT-4-119 ( <br />Metes & Bounds (Unplatted) <br />Contractor KEN i{ovDir— <br />Sec. Twp. Rge. <br />Address ) <br />City _�NNwoor� Phone <br />State License Number <br />Expiration Date <br />Building Use Q_F_c taabc )1Fa <br />Describe Work to Be Done <br />�A-LcoN,� �OfZ ChFE SF q-., nf�L <br />Number of Stories <br />Basement r'j o <br />New Addition Repair/Remodel <br />Valuation of Construction $y 0i <br />Signed By e�(? <br />For <br />`Owner Phone 77�-z366 <br />Do Not Write Below This Line -For City Use Only <br />Date Received 111,-&17 co <br />plan Check Number <br />Valuation-!YO00- aG <br />Permit Fee .3Z•9-0— <br />Plan Check Fee 2 O.ame- <br />Total Fee Due 52,E <br />Date Issued 10 <br />Use <br />Sone <br />Fire <br />Zone <br /># 3 <br />Occupancy Group _ <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />