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c <br /> ,,�/3 — 76 <br /> /�s�` <br /> BUILDING PERMIT APPLICATION <br /> Applicant To Complete This Porm �/•�c/7L� <br /> If more than one bui].ding is Y.o be constructed, submit a separate permit <br /> application for each building. A separate permit will be issued for each <br /> building;. � /' � <br /> Owner i/���✓ �C t: !y� Building Address ��/�� � `'��� � <br /> Address i%�� ��/z�'l'Y�✓�j �� Lot IIlocl: <br /> �+ <br /> City �- �'c`�E`r'_ 'y� Phone ���� Subdivision (Plat) <br /> nrchitect/Engineer <br /> City Phone Metes & Bounds (Onplatted) <br /> Contractor _ - �,z ' ��r. � � � ,� Sec. Twp. Rge. <br /> Address v?/? 2_ /L j��jc; � <br /> Citp .El�/�f� Phone �Sj-SS�G <br /> State License Number <br /> �xpiration Date <br /> Building Use � �r��C'f' _���cr i� <br /> Descri.be �9ork to IIe Done <br /> //�P /LI I� �! F / ��I CC�O T� <br /> NumUer of Storics <br /> IIasement <br /> Neca Addition Repair./Remodel <br /> Valuation of Construction $ <br /> Signed IIy <br /> Por <br /> O�oner Phone <br /> Do Not h'rite I3clow Thi.s Line-For City Use Only <br /> Date Received • Use Sone <br /> L�lan Check Number Pire Zone l <br /> Valuation Occupancy Group �' • t <br /> Permit F�e Type of Consi:ruction � <br /> Plan Chec',: I'ee Occupant Load <br /> Total I _ llue Sprinklers Required <br /> Date Issued <br />