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' , • DUILDING PERMIT APPLICATION • �/J-�� �• <br /> � • 71p�ilicanL• To Compl.etc 'fhis Torm� 'j/`� 3�a�7� � <br /> If more than one building i.' to be constructcd, submit a separ.aL•e per.mi.t � <br /> appli�ation for each buildinq. A �c!parale permiC will he i�auccl L•or. cach • <br /> buildinq. 6 £ <br /> �C Owner :7� 7�/�r'!')A S IIuilding Address �'71 8 !�w�Trl�t�� <br /> Address I'-71 Fs �e u,� rr rrv� �L 3 I � �2 I31oc1: (�8 �/ <br /> City �.l ��z�'rT Phone Z� — 97 SubAiyision (Plat) [�UF 2�Yr . <br /> Arehi:tct/Engineer � • <br /> City Phone Metes & IIound� (Unplai:t•ecl) — <br /> Contzector � ,�,�i �,c�,ovrmR� 8ec. 7�vp. Rge. • • <br /> Address •t�• rJc'.J k �OS3 <br /> City �,ij rT Phone 3?l-� l Z�� • <br /> State License Number . <br /> Expizztion Date <br /> � . � • ' Building Usc �S�r}5 S-t�or� --_- <br /> � <br /> ' Describe �•�or}: to Be Done <br /> C01�T�__ PLOT PL/:17 02i REV�RSE SID� ��" '���� � 1Rt�s-- <br /> � Number of Stories I <br /> . ' � . Basement ION� <br /> � • . ' ' ' " New � Addition .Repai.r./Reriodel' <br /> . • � � •_. . . Vuluation of Con�truction $�Oo« <br /> • . Signeu IIy � � <br /> � • For �,� ��rrr�a-✓ <br /> ' Owner • Phone ,,z�'y� 7/37 <br /> � �• Do rot t•7rite IIelow Thi� Linc -ror CiCy Use Only � <br /> Datc Received � ' ' ' ' ' ' '• �" Use Sone ` � <br /> Islan Checl: NumUer ' • • Firc: Zone <br /> Valnation � ' • Occupancy •Group . <br /> Pernit Fee • . Typc of Cons�ruction ' <br /> Plan Check ree " • Occupant Load <br /> Total I'ec llue Sprinicicrs Required <br /> Datc Issued �. • , . <br />