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' � :��.�- it:, . <br />• • IIUILDING PTiRh7IT APPLIC71TIOi] • / j�,� • <br />• nPPlic�nt 'Po Comp].etc This 1'orm � 3�s%��- <br />T£ mo:e than one bui.l.di.ng i,�to be constructcd, eubmit a sepzr.�it•c per.mi.t <br />applic::tion for each Uuilding. A sep�irate per.miL wi.11 he issucd Lor ezch <br />building. ' <br />�' Oamer E�� �,�lsi/,>��r IIuilding I+ddress � j`Z 1-it '•/% <br />Addr.ess 7i �/i - �/'� 5i . .�r�r� ,- T Lot �, / D Aloc):. � X `a <br />City r'ii�re-�� Phone � ;y--S,='- Subdivisian (Plat) - �,r= �G'r✓t'%/ <br />Architect/Cngincer YC / c, ,n� .� -.1"�Ll e' ��- <br />City Phonc 14etes I� T3ound� (Unplattecl) <br />Contracl-ar Sec. T�•:��. l;qc. <br />%KCl�rr.�5 <br />City Phone <br />Statc iicease Nu;nber <br />Er.piration Date <br />Building Use '�i�J; 5 � <br />� Descri.be F7or1: to Be Done /�/�/'� <br />"PTt �`T` � t'.., � � � �� �'T L�C[ /^.�✓� (� LC✓.� � C=c'r',Y <br />COr:..,__c PLO_ PL611 Oid P.E��'!'SE aII,� �— <br />Nunber oi Sl-ories �i <br />. Bas4ment �'/�// <br />. • �' laew Addition Repa�,r./I�baodel' <br />. Valuatiun of ConsL-ruccion $��r <br />9 <br />Si ned II � '`��.���-��- <br />5 Y 1 .'�-n ����/- <br />�Y FOl' �����aT� '�T -GL�'i;L'C K ,. <br />. rr� <br />Owner � Phone �; ?-� � %G'7 <br />• ' no 1'ot �•tritc I3clo�•r TP�i:: Line -For City Usc Only <br />DaCc Received " " " � � Use Pone � __ <br />Islan C;�ecl: Number ' • Tirce 2one _ <br />Valuation ' • Occupancy•Group _ <br />Pemit Fce Type of Cw:str.uc+�ion ' <br />Plan Check I'ee Occupani- Load <br />Total T'ee Due Sprinlclers Required <br />� Batc Is:,ued � . <br />(• " <br />• ' - ' ' , , , �. <br />. � . <br />