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• • IIUILDING PRRI,IT API?LTCATIOi7 . �G "I - �� <br />• • , f!n 3 <br />' Applicant `Po Compl.ete 'J'his T'orm 3�c 7� <br />If m�re tha;� one bui.ldi.ng ic�to be construci:ed, suUmit- a separ.��L•e per.miL <br />application for cach building. A separate per.miC wi.11 he issucd for azch <br />building. , � <br />Owner �_����" �'�"�'�`' Du•ildinc� nddress % 7 ZO�=��� <br />— � <br />Address y7 � p G`�i,����n,��-� wv-�� Lot 131oc): <br />City (,��,r tic� Phone �S-�-i/o'�' Subdiyision (Plat) • <br />Architect•/Engineer � <br />City Phone Mete, b T3ounds (Un��lai-ted) . <br />� c °a�'U.o-�-w- � Sec. Tt.p. _ Pqc. <br />Coritrac or � Ci.�-:�-�, t. <br />kddr�ss <br />C'ity Phone <br />State License Number <br />Er.piration Date <br />C01•i'T.,_,T'•_^ PI,OT PLA11 ON REL'E?tSE SIDli <br />�• ' Di <br />te <br />Date Feceived ?> >/ �� f : ' � � � � <br />ilan Check Numbe� --" ' • <br />Valuation 30�• ��' ' • <br />Pernit Fee •Z�. ��� <br />Plan Check Fee � `—" <br />Total Fee Due � �•`��� <br />patc Issued .`>�! G �7 �� • <br />Building Use <br />Describe �7or1: to Be Done __ <br />1�L�,r�c r-� `�.�9—Yc� <br />:�umber of Stories <br />Basement <br />' Neca Addition Repai.r./Itemodel' <br />Valuation of Constxuction $ <br />.� �a f> > a , �.___� <br />Signed IIy `��3 �iJ �-c�rc�=�t . <br />• For <br />Otaner • Phone <br />Line -I'or City Use Only � <br />Use Sone G" / � <br />Firc 2one '�� <br />Occupancy•Group _ <br />Type of Con�'tr.uc{:ion <br />Occupant Load <br />Sprinlcicrs Required <br />