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;�;' ' . ' • DUILDING '� t�M T �PPLICA`PION • .'?�S- ��' <br /> � • Ap�ilicant To Comp].etc T.his 1 orm� � ��6�/���7� . <br /> If more than one building i,� �o be construcCed, submit a separ.ate per.m�.t <br /> applicaL•ion for cach building. A �eparate permi C �•?i.l l b e is_u c d f o r. ca c h ' <br /> buil�ing. ��s� ,Sxd�`. I �, <br /> Ovmer � � D U c� , . . > ;, '��,'-. , ��'� Buildincj Addres� 3(nU ��i1<:�;;;: <br /> ` � �� (�"u' Lot � � — ;.� I31ocl: <br /> liddress �;a C `�l `�� S U/ . <br /> � �� Phone :::.�: ;�- ''� '+ ci r' Subdivision (Plat) • <br /> City r' �,.��„ f <br /> Architcci:/�ngineer � ..,•.� �! . ,. .. '/ �,; 1 � ,�� � <br /> City ```�z., , %� _`Phone ;�a.�0vy Metes &+ IIounds (U�nplat-Lecl) <br /> :- . <br /> Contr�ctor C�i1i.�� % � „� :�r /�� ,•;; Sec. T�ap. _ itge. - <br /> �. <br /> Addr�ss � 1,�,.. <br /> City :.�. , ..�t.' Phone �I 5�'"- 'l/S" I • <br /> State Licease Number �,', <br /> Er.pirztion Date �.� <br /> ., fJ <br /> . • r,,, . <br /> .. • �7, i <br /> - .• . ' . $ll11C�111C� USC •� �._�i� �' ;'.•`.. <br /> - Describe �9or}: to Be Done <br /> • .I�d.�..Qil �.lP.t.�.. I �., r��,�.�_e. <br /> C01^�T�':__ PlOT PLGtl 02r' REV�RSE SIDL • <br /> Number of Stories j <br /> � . " IIasement Lt }� <br /> . � . ` <br /> ' • . � ' " i�et•r � Addition .Repaxr./Reriodel' <br /> � Valuation of Con�t�uckion $ <br /> . . . ' - � _;; ��r �; � � � � . <br /> . � -� � - <br /> . .. � ��--� , / <br /> . . 5igned Dy � )f)�,. • ,c . , <br /> ' . For �1��� <br /> ' Owner • P1�o�ie <br /> Do Kot [•;rii:e Beloe� This Linc -I'or. City Use Onl � <br /> Datc Received � �f � ' � � � • • Use Sone �_ ' <br /> 1s1anC:iec1; Number Lo- /7•% • Eirc. 2one <br /> Valuation q_� �{D�t• �� ' • Occupanc.y •Group , <br /> Pernit Fee � �,'�1 � �� . Typc of Co�isi.ruct•ion � <br /> ilan Cl�eck L'ee '�3•�'-� � Occupant Load • <br /> Totzl Fec llue ^ Sprinlcicrs Required <br /> Datc Is�ved ' • • <br /> , , . . <br />