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- � ����/9- %� <br /> � � � <br /> _ BUILDING PERMIT APPLICATION / / <br /> Applicant To Complr_te This I'orm P�j/,L <br /> / <br /> If more than one buildi.�g is to be constructecl, submit a separate permit <br /> application fur earii i�sildiny. A sc�parate permit wi.11 be issued for each <br /> buildinq. <br /> 04mer ��,Nf,T ,� ��. /�r'� IIt�i.lding Address �%ti�>�: ' <br /> � �;'b:r. � . <br /> ndaress (� � � Lot ,L.�;� �S� Block <br /> City � Phone �l-�,� Subdivision (Plat). ��J� <br /> Architect/�ngineer _ <br /> Cii:y Phone t9etes & IIom�ds (Unplatl-ed) <br /> Contractor � - � L,z, Sec. Twp. Stge. <br /> Address �Q }�jr)c �7�5 <br /> CitY „ ��rr��f Phone � 1 -`��/� _ <br /> Stat� License Number�f�-���'�S�(,}x <br /> i -- � <br /> E>:piration Date //-/,2 ^ 7� <br /> Building Use <br /> Describc P7or}: to IIe Done <br /> Number of Stories <br /> Basement <br /> P:e�•� Addition Repa�_r./Remodel <br /> Valuation of Construction $ <br /> — ;— <br /> Sianed IIy � ,� ' <br /> ror. � <br /> Ocane_ Phone <br /> _ Do Not �Vrite Be.low This Linc-I'or City Use Only <br /> Date Received Z�3�7�/" • Use Sone <br /> � <br /> ilan Chec}: Number '7Co/Z � Pir� Zone <br /> Valuation 2C�� ��.�`�' `"J Occupancy Group <br /> Permit ree �lO- � U' Type of Construction • <br /> Ylan Check Fee 5`-r=�-��G Occupant Load <br /> Total Pec Due SprinY,lcrs Required <br /> DaCe Issued <br />