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. , � . , . <br /> � 13UILDING YI'sRt�lT APPLICATION • :i,5 `�` � , <br /> • Ap�lican� To Completc 7'his 1 orm � �� � <br /> 3/._=.r�� <br /> If more than one building i.� to be con'sLructcd, submit a separ.ate per.mi.L <br /> applicaL•ion for each building. A scparate peLruiL• �aill he is�ucci fo�: each <br /> building. <br /> Ovrner � A-nf �-e.�J IIuilding Address <br /> � Loi: �. L� c� I31oc1: �o y� <br /> Address [F�0 ( � - '. , � <br /> City F'rl¢��� P �one ��Iy� Subdivision (Pla1:) � � �n- r��F-- <br /> ArchitccL•/�ngineer �'��— \' <br /> City Phone Metes & Bounds (Unplatted) <br /> Contract-or �o i� $� ��n..a�iLV {„c�, Sec. T�ep• Rge. • <br /> Address �o`F�v ` �-r z C c-'� <br /> City / ,��nU c� ,.��1 Phone� � b 1l`Z ' <br /> State License rumber 2 a � 0 2 �h�o � <br /> Er.piration Date <br /> ' Building Usc • ' �o�- <br /> ' Descr•ibe t•Ior}: to Be Done <br /> �� �� � <br /> C01•T?,�=_• PI,OT PLAN 0?1 REV�RSE. SID� <br /> Number of- Stories <br /> � . . IIasement <br /> - • •• New Addition Repair./Remodel' <br /> • ��o <br /> . Valuation of Consi�ruct-ion $ •J� <br /> . ' ' . • • .J� f p-�...� -�c�. <br /> .. , giqned IIy � � -f-� �$-C�- . <br /> � . For �_�1 e u�� <br /> � Phone <br /> ' Owner � <br /> � • Do t:ot j�7ritc llelo�r This Line -P'or City Use Only � <br /> Date Feceived 3� ���7 L� � � � � • • Use Sone � <br /> Zslan Chec1: Number ��� ' • Firr. 2one <br /> Valuation 2�/5- `� ' • Occupancy •Group . <br /> Pernit Fee �. �� • Typc of- Cw�sLruci:ion �_ <br /> Plan Check Pee ' Occupant Load <br /> Total Per� Auc �J : � Sprinlclers Required �_.. <br /> Datc Issued ' • <br /> . , . <br /> ¢�lI%�'/32'�1� 7z � /vl,�X ' . . ' • • _ . : . <br />