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• AUILAING P13RMIT APPLICA�rxota � 33y � G �� \- <br /> . � . � 3 5� <br /> • nPPlicanL• To Com�,�].ei�c 7`1�3.s. 1 orm �,�jj,�9� ' <br /> If more than one building i,� to Ue cons�ructcd, suUmit a separ�i•e per.mi.L- <br /> application Lor each bnilding. A scparate permii: �a5.11 be is:.ucd for. cach <br /> building. <br /> pvrner l�iL)1�� �D���uSch) <br /> Ti�, , Buildinq Ac3dress 7�t � ��'��2�i%��J�' <br /> I31oc]: <br /> Address ! �`100 5t U -+C' L���2��2. Loi: ___ _ --- <br /> City LUZ�2��?, Phone ��'j,'3J-`ii�� Subdiyision (PlaC) ' <br /> Archi�eci:/Engineer �>>��`r <br /> City Phone Metes & IIound� (Unplatted) <br /> ContracL•or / �� l7UC)(�%�v� ���S Sec. T�.,p• Rge. <br /> Address �>��� �nh'�'iiJL SL <br /> city �>>�2�� rhone�3�-35`�3 . <br /> State License t�unber%/�-IJU� 1'1 Z�fS� � <br /> Er.piration Date �� — �� �� <br /> • � Building Usc �/� uSL_ <br /> � Describe �9or}: to Be Dore �� -ra <br /> � �„-�., �.a _ <br /> -1.�__ti=.7 <br /> COI•�� PLOT PLAI7 OV fL�V�RSE. SID� <br /> ' Nuinber oi Stories � <br /> . • 33asement /DC'�tR= _ .— <br /> .' ' . . •• � y�,e�.� � Additi.on Repair./Remodel� <br /> V�a ation of Const�uclion $ <br /> . . . . ' • . � '//�G�L� n-� <br /> � Signed IIy . <br /> � . For _ <br /> ' Osaner � Phoi�e �_ <br /> � �. , Do t:ot T�7rite IIe].o�•r Thi., Line -I•'or City Use Only,�,__. <br /> Date Received " ' � ' • �� Use Sone ' <br /> Islan Check Number ' • Firc 2one <br /> Valuation ' • Occupancy •Group . <br /> Permit Fee • . TyPe oi Corist�:ucl:ion ______ <br /> Plan Check P'ee ' Occup��1� Load <br /> Total Pee Due Sprinlcicrs Required �_____— <br /> Datc Issucd ' <br /> . . <br /> . <br /> � � <br />