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IIUILDING PI:RMI7' APPLICATTON <br />Applicant To Complete This Form <br />/,'% -; � � � <br />�� � � <br />If more than one bui.lding is to be constructed, submit a separate permit <br />application for each building. A separate permit will be i.ssued for each <br />bui.ldin9. �i�Oj71�� IJ <br />) h ! <br />Owner �/,r/,�7ci �:�i�l /�Q��l — <br />Address �1-J �/ /•�r I`-'/i �l <br />G.ty = �%j%i.� /�_ Phone SSS�-% 1 �� <br />Architect/Engineer <br />City _ Phone <br />ContracCor (• % /' G i � �,- ��7 _ <br />ndclress �L_�_�:�_� <br />Ci_ty Flyi�<' l _ Phone =5-3 (��'27(� <br />State Li.cense P:urnber = 7 3' �'%-�C/� i� <br />� <br />L'y:pirc.cion Dai:e �;�,/�_,' `> n _ <br />Do i�ot l•Irite ]3e]_o�a 'L`hi.� <br />DaLe Feceived �� /�Q �7(G�' <br />I�ian Check Numbe�` ' 1(c -/D � <br />Va.luation Cr�"���. �� <br />Permit I•'ee 3Cp. � <br />P1an Chec}: Pee �8. � <br />1'otal ree Due ��-• � <br />D<1{.0 T�iUCCi <br />Building Ac'3ress 2��- ���:_I U <br />DnR j — <br />Lot ��� �� � o Block <br />SuUdivision (Plat) v.��v:�f v�ti`� <br />Dletes & Bounds (Unplatted) <br />Sec. 'Pwp. _ Rge. <br />IIuildiny Use C Y �2-;' ���,_.,�t c.0 _ <br />Pescribc F1or}: to Re Done <br />_ . � � .. <br />+ i' �� <br />�_l� ,�L�J C <br />P:�.:mber of Storics <br />Rasemc:ni-, <br />New Addi.tion Reuair./Remodel <br />[C <br />Valuation of Construction $ �, ,GfC � <br />�l � �. . <br />_ , j i 'L�- <br />Signed By G,='� / � <br />Por. <br />Ocaner Phone <br />Lin�-Por. City Use Only _ <br />Use Sone � ( SI�+Lc.G:; �GWS ��tJi <br />I'ire 7one ' <br />Occupancy Groun t <br />Type of Construction _j�- �� <br />Occupant Load _ <br />Sp1-inl:lcr.^, P.cclui.red <br />CITI' OF [VcRETT <br />I�PPROVED FOR [3UILDING PERMIT <br />lla�_�„ � �—BY � r _ <br />_'_,% � � , _ <br />