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J� ' <br /> � ' 3`I=��� •` . <br /> • DUILDING PI's121•1IT APPLICn'PSON • , ' <br /> . , � • ,2 J ' <br /> . �p�J1.1C111{: TO Com��].elc 7'hi.s lorm �/��/Jk • <br /> IL• more than one bui.ldi.ng i,� i:o l�e constructed , suUmi� a separ.��L•e per.mi.L- <br /> application for. each building. A aeparat;e perntiL• �ai11 Ue iscuccl for. cach <br /> building. , � � �� �� <br /> Owner �7 (' � riuS..l����. A��ess .�/ �. -�� <br /> Lotw� i -tt / - I31oc]' <br /> Address �',!L� '�`�� •`�`r 1������� / <br /> Cit ��' �L- Phone _ Subclivi ion (1�laC) f ,,.J <br /> y c..,,��, �� <br /> Architcc�/Engincer ,/1-n� � — <br /> City Phone Mete, &' IIounds (Unplattc:d) <br /> }>_ Sec. T�ap, _ ]:ge. <br /> Cor,tracL-or �� � � � - =' <br /> Addre�s �� �f�.�� �rvr-�c-- <br /> � . <br /> City � ✓LLc� Phonc �<�.�-. .� <br /> Statc License t3umber�� -�.dv�/�-��33i%VI f <br /> Ey,pizetion Date �'" � �� <br /> ' ' Building Usc ' / <br /> Describe I7or}: to De llone� ����t <br /> . i i > <br /> r�� , " � ��- O ,� <br /> COhr:,_"'�' PLOT PLl�td ON P.EV�IiSE SID3 <br /> � <br /> P -- <br /> Nuinber o ' Stories <br /> � IIasement <br /> • • •• i�ew Additio�i Repa�,r./Remoclel <br /> • � n <br /> Valuation of Constr.uction $� <br /> Signed IIy -- . <br /> ' . For ----- <br /> ' Owner Phone <br /> � �. Do t�ot �•trit;c 13elow 'Phis Li.nc -I'or Cily U:��ly <br /> DaCe Reccived ' ' ' ' • � Use Sone ' - ' <br /> lslan C�iecl: NumbeL ' • I'isc: 2one �----- <br /> Valu�tiou ' • Occupancy •G�-oup . <br /> Peir�it ree • Typc of Con:�i:riici:ion �_ <br /> Plan Check I'ee ' OccupanL• Load <br /> ToL•al Pec llue Sprii�lcicrs Requir.cd __________ <br /> Datc Issucd � <br />