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� , • DUILDING PRRMI'� APPLICATION • ��6- l� , �• <br /> • llpplic<�nt To Comp].ete '�his rorm ' 3 � 3/�s/�� <br /> If m�re than one build3.ng i,' to be constructcd, �ubmit a separ��te per.mit; <br /> appli��at•ion L•or cach buildin�. A sep�Yrale per.miC wi.l7. hc issucd for cacl: <br /> building., � • <br /> Owner �i,.2-,. - �i%,;. r � � IIuilding Aadress /7 /': !/-•,. . -�-� �� <br /> , <br /> Address� ��-�<�� a'j'� '� c�5 C� ' ; Lot Alock � � � <br /> � - , <br /> City��:� Z`�r: C/ . Phone � , SS-/� �`, Subdiyision (Plat) • <br /> Arahitect/Engineer S r'.� • • � • <br /> City Phone Met•e, h I3ounc3.^. (Unplattc:d) <br /> ContracL•or Sec. T�ep. Rc7c:. <br /> Addz=.ss <br /> City Phone _ • <br /> Sta.e Licensc Number • <br /> Er.pization Date <br /> • � � • Bllllding Use ,n� i 't �=,i,;';=' <br /> � � Describe {9or1: to IIe Done��.�� ,-� <br /> . ' r, <br /> CO2•P1a.T"�� PLOT PLAN ON RE4ERSE SIDE � ��, � J ! ,�,' i•, - i .• + <br /> / , <br /> � , / � <br /> � .. �i'l >���Gtit r�� ' ,cv Cil <br /> • . Number of Stories / . <br /> ' . . • ' � . Basement �J C�' <br /> . ' ' � • ' ' •' New � Addition RepaixX emodel' ' <br /> , , . ' �. Valuation of Constructi�n $�� <br /> � . . . <br /> • • , . . Signed IIy %. � n, , <br /> . • . . For � <br /> � Owner • Phone • <br /> , . <br /> ' Do t��t �•trite IIclo�v `Phis Line -For City Use Only ' <br /> Date Received • " " " • � Use Sone ' • � <br /> IS].an Check Number ' • . Firr. 7,one <br /> Valuztion ' • Occupancy •Group • <br /> Pernit I'ee Type of Construc!:ion '_' <br /> Plan Check Fee Occupa�tt Load _, <br /> Total Fee Due Sprinlclers Required <br /> Datc Issued • , , <br />