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i <br /> � ?��- 7� <br /> BUILDING PERMIT APPLICATION ��7, <br /> nnni ;r:,nt T� r�mplete This Porm <br /> ..------ ��7�71 <br /> If more than ore building is to be constructed, si+hmi� a s�Pfir]t:r perric ' <br /> ��PPlicai:ion ror each building. A separate permit will be i.ssced for each <br /> building_ <br /> �/ 30 `L- <br /> Ol•�ner �JLi11i.d<' ��P� Building Address r= G'�.f�-,>;�.,., <br /> l:dd'r�ss ,�C � � „ � <br /> Lot- ,G�� _�� glock <br /> Ci:y -�r� Phone �7- 1�/� Subdiyision (Plat) <br /> Architect/Engineer <br /> - ' ir--=' �-�,-- <br /> City Phone Metes & II�unds (Unplatted) <br /> Contractor S� • + r ��e,/ ���r �� Sec. Twp. Rge. <br /> Address �Q <br /> City r�,n-��f Phone � . -5Z�`� - <br /> StaLe License Number�_�=_S� ^ �5��}� <br /> E>:piration Date 7 <br /> ���/� — 76 <br /> IIuilding Use <br /> Describe I9orY, to Be Done <br /> Number of Stories <br /> ]3asement <br /> New Addition RePai,r./Remodel <br /> Valuation of Const�uction $ <br /> Signed IIy ' <br /> Por ' <br /> Owner Phone <br /> Do Not 1•7rite IIelor, This Line-I'or City Use Only <br /> llate F.eceived 2 3 '7 • Use Sone ,[�� st <br /> r �4L� �'-ast.+. �u>_- <br /> Lslan Chec}: Number `7(0-/'�-�- � Pir� Zone 3 <br /> Valuacion ZDi �s<,�.E_� Occupancy Group <br /> Pernit Pee ��- �� Type of Construction . <br /> Plan Check Fee `mJ <br /> �' -- Occupant Load <br /> � Total Pee Due Sprinklcrs Requir.ed <br /> " ,� Datc Issued <br /> i <br /> I { <br /> � �� <br /> � �� <br /> ,, <br /> ) � _ <br /> , / <br /> j <br />