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- J JG ._•�/C . _ <br />�S� <br />IIUILDIC]G P�RA7IT APPLICATIOI4 <br />��`'" i � <br />Applicant To Complete Thi� P'orm <br />If inere than one Uui.ld.ing is to be constructed, submit a separate permit <br />application !cn� er:ch building. A sepai�te perMit c•;ill be issued for each <br />bui]d'_�9. <br />Owner ���L'��L/ �?UUT _ Buildinc� Address �,�%1� .«:N/�.!=�v l��' <br />/O, >!r c. G�ac icr . <br />Address Z9��? !_.Ec.t-'���/� ✓�.e. Lot __ B19oc}: i/ <br />city Fi,c,2�i T Phone 2;� i57E suliaivision (r-1at) ,Pf,�� L,oti.� _ <br />, <br />Architect/Engineer �,��5' sI.OD rr 6��/�F---- _ <br />City Pltone A7etes & Bounds (Unplatted) <br />Cor.tractor >,l,r",yDil9iSif /'o. :�LD%�5 Sec. Twp. _ Rge. __ <br />Address g��1� �c �fi',C�'�'FFN �✓ `/ <br />City r-!/ci'FTT Pr.one 3, 5- -5-% % _ <br />State License NumUer �- �t/– //'> � ��'_ _— <br />Expiration Date '�_ /– '7 % — <br />� / <br />L'uilding Use �/rr,�/.r,ro-.=_ <br />Describe Work to IIe Done <br />, <br />�� �,cJ or <br />�6'C�OF /7O6�c B K .l�i� <br />/� i /� <br />��,•q�'LL l7�[�� 07v .C�FG�Y" Gf .'��1�$� <br />i / <br />I.umbar of Stories <br />Basement _ <br />Aew nddition Pepair/Remodel <br />Valuation of Const�uction $�1�,(,�C.� °` <br />Signed IIy i �j/ �. /; !/_oc:✓ <br />Por <br />Do i4ot S4rite 13cloe� This Lin <br />Date Received <br />151an Check Number <br />Valuation <br />9� � `-t �--�� C`D <br />Permit ree <br />Plan Check Bee <br />Total Fee Due <br />Da�e Is�ucd <br />Ovmer Phone S; 7 '7/�/ <br />Use Sone <br />I'ire Zone <br />Use On <br />Occupancy Group _ <br />Type oE Construction <br />Occu��nt Load <br />Sprinklers Reqt�i.r.ed <br />