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� <br />a <br />. . ,�� �.� <br />, ,._ <br />. • 13[]ILD7NG PIiRI•1I'1' APPLTCATIOP] � :J 7� <br />. Applicant 'Po Complc:te 'J`hi.s 1'or.m ' � / •-'� - <br />3'- , <br />Tf r�ore t_han one 'nui.lding is�to be con�tructecl, �ul�mit a separ.aL•e permi.t <br />appl;.c��Lion ior each buildinq. l+ sep�ira�e per.mi.t aii.11 be issi�ed f:or. e�zcli <br />Uuilding. — <br />Oorner f, J- ���V'��/C _. IIu•ildin9 Address ..1�?2 1iDY/ <br />naar. _�•s �, fl - l�31� /y �`� — <br />city �-r,E'-t'7� rhone 3 �`Y-�) �'-Z`� <br />Rrch�tect-/13ngincer �7�� �n� �' <br />City � , %Y Phone <br />Cont-actor SA �^ � <br />Isddr�_�s — <br />City Phone <br />Statc Licease t�umber <br />Ezpirztion �atc <br />co���- rLc^ rL�,?: o:; i, ;�:� .���, s��r•� <br />„ - -- . <br />D o I�' <br />Datc Feceived _ <br />is].an Checl: NumUer <br />V�lu�tion __ <br />Pcrr;it rce _ <br />1'lan Chcck ree <br />�lotal Ft.c llue <br />U�it�.c Issuccl <br />Lot / 7` ) �' )31oc1: �-i �(� <br />SuUdivision (PIaL) �vP�'P7� <br />� i �� ,�, _ <br />Met-es F� IIounds (Unpi�llccl) , <br />Sec. T�:�p. i:gc. <br />Eui7ding Use �t� G'N <br />Describe �90�:1: to L,e Done ���/L <br />.= OvNJ7Ai �J•✓ /),vC�Y�' �Or t <br />humbcr of Stories _5 ___— <br />I3asementi �1 { � <br />' l�et•: Addition epa�-�r,I:emo:�.e1 <br />�. <br />Valuation of Construction $� (/ � <br />Signed IIy � • ' ""'� <br />�.ror ___—__— — <br />Ortncr Plx,ne ___ <br />[•;rite I3clo�•: 'rhi . Li.ne -Por Ci.i:y Lsc (�n <br />Usc uonc <br />I� irr 7,one <br />Occtipancy �Grou}� , <br />Type o� Con;truction <br />o��U�����,t� r,o,a <br />5prin1:7.crs ]Zequired <br />