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� <br /> IIUILDING PER*fIT APPLICnTION <br /> Applicant To Complete This Porm <br /> IL- more than one building is to be constructed, submit a separate permit <br /> application for each Uuilding. A separate permit �vill be issued for each <br /> Uuilding. <br /> O�vner �,c/ � �)F,,/ Building Address _ J�j/c}� 1: ✓i_7%'-i7L;✓C, <br /> Address �_ Lot Block <br /> City Plione Subdivision (Plat) <br /> Architect/En��ineer <br /> City Phone P7etes & Bounds (Unplatt��d) <br /> Contractor Sec. Twp. Rge. <br /> Address <br /> City Phone � <br /> State License Number. <br /> Expiration Date <br /> G/�tt,���� o�- �-�-6 c <br /> ��l/Zi�til���lL'i2 �2C� /�/��i��t� IIuilding Use �,r(,�i�g �7c/t )i�� <br /> v7���J���' Describe Idork Co IIe Done <br /> i2� �t7�e��.c�i 7e: � C''.c�.0� <br /> - ) -� � ��t]ct1��L.,�l�ALlr <br /> � J /���'t�7-�1/'✓�� �c� �- �C� i�/fn/Gc ` <br /> J r.����� \umber oL Stories � <br /> Basement ,�ld� <br /> New Addition Fepair/Remodel <br /> Valuation of Const�uc'cion $ <br /> , <br /> i <br /> Signed Sy � .o <br /> For � <br /> Owner Phone <br /> Do Not tti�rite Below This Line-Por Ci.ty IIse Only <br /> Date Received / i ���� Use '�ne <br /> l�lan Check NumUer Pire Zone �� � <br /> Valuation —� Occupancy Group�3��� <br /> Permit Fee � Type of Construction <br /> Plan Check I'ee Occupant Load ,��j <br /> Total I'ee Due Sprinklers Required <br /> Uai�e Issued <br />