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, . say�-� <br /> ' • ` Ap�lic��nt• To Compl.ete '�his, I'orm� ' ya� j�j�`,� <br /> If moze than one building i,' to be constructcd, submit• a sep�r.nt•e e .m�. <br /> applicaL•ion for cach building. A �epsrate permiL• will hc is_ucd for. cach • <br /> \ buildin���� ' �'1 • ` r � <br /> i Owncr �>r `� ���' IIuildinq Aadre.,s � 7�� ��'��=`a' <br /> Aadress �OS� i7 ���`- /f/' Lot o1�3 nlocl: (, .',-;.� <br /> City :�• ,,��,-,. .. Phone ,�`.='����>'' Subdivision (Plat) • <br /> Arehi�ccL•/Engineer � �`�4' �'"� "��`'� <br /> City Phone/ Metes &' IIow�ds (Unplcitt-ed) <br /> Cont.actor ///,.f� , �-' ,�, u�`� Sec. Twp. Rge. • <br /> � - , <br /> Addr4ss .G. ,.o.n_ <br /> City ,!:., -� Phone ..c�•-=-�t- ' <br /> State License hunber ,�:t 3- o /- G�G 9 <br /> Er.piration Date -� � —%�L� " �� <br /> . . �- Building Usc � Gv,;,�� G.�=� .. . <br /> ' Describe �•:or}; Lo Tse Done <br /> . . ' �� .��� <br /> COIf"�== PLOT PLAN 0?: fL.�IiSE SID� _ • <br /> . Number of Stories �i _ <br /> . ' . Basement /� O <br /> . , • • •' ew Addition Repaiz/Remadel <br /> : • �. � • . Valuation of Consiruction $(>� <br /> . , � Signed IIy <br /> . . • . For �1—�, /���i:�i-<-..�....� <br /> � Owner • Pho�ie '�`/-i�'c9 <br /> � • Do Rot [•:ri1:c IIelo�a This Linc -I'or City Use Only � _ <br /> Datc Aeccived %'. %.'' 7 �v ' ' ' ' � ' • •� Use Sone ' ' <br /> Iflan C:�ec}: Number 7�%Ls ? ' ' . Firc 2one = <br /> Valu�tion (o��,��• �'-� ' • Occupancy •Group i\ <br /> Perr.�it Fee 2/7+ °U . Typc of Construci:ion _ J ' � <br /> Plan Chcck I'ce %4-/• �S • Occupant Load <br /> Total Pcc lluc Sprinlcicrs Requircd <br /> Date Issucd � ' <br /> CIl Y 0� F"ERETT <br /> � • • - Af°PROVcD FOR,BUILDING.PERMIT <br /> . . • � , `/`j _'�- • gy� <br /> . • • ' Date--=-- <br />