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- .3/7- �� <br /> IIUILDING PERMIT APPLICATION � � � <br /> � App]icant To Complete This I'orm ���/7� � <br /> If more than one buzldina is to he constructed, submit a separai:e permit <br /> applicalion for. each building. A separate permit will he issued for each <br /> building_ j ' <br /> Owner �.c,a�.�s• (I�� Building Address ��."'��,�� �=,. ,�'t��=�-�t.,; <br /> Aldress (� E,� Lot ,L.�� �7 Block <br /> City ^. Phor.e �T-y�l� Subdivision (Plat) T16i�sn.����t_ <br /> Architect/�ngineer <br /> City Phone Aietes h IIourids (Unplatted) , <br /> Contractor �=�r�. ('�� ��, Sec. Twp. Rge. <br /> Address �O �[f)c ��7rZ�7� <br /> City ��-_�T Phon� �/`f . __ ! <br /> State Licenss NumUer �f}-/y/�—S(� ^C.'tS6�iC _ <br /> Er.piration Date //—/,� — 7� <br /> Building Use <br /> llescribe F7or}: io IIe Done <br /> Number of Stories <br /> IIasement <br /> rew Addition Repair./Remodel <br /> Valuation of Construction $ <br /> Signed IIy � <br /> Por / � <br /> Owner Phone <br /> Do Not S9rite Belo�•: T}�is Li.ne-For City Use Only <br /> Date Feceived 2��,��{v • Use Sone � � 'S%.c.f,c_��. GUCt'% <br /> L�lan Check Number "���-/�,�"� Fir� Zone�3 <br /> <r-�, a-�� <br /> Valuation 2� � ;�,� Occupancy Group _ <br /> Permit Pee �!�'- �`� Type of Constructiun _ • <br /> Plan Check I'ee ¢c� `� Occupant Load <br /> ToL�l Pec Due Sprinklcrs Required <br /> DaCe Issued <br />