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�S� 7� <br /> IIUILDING PGRMIT APPLIC7ITION IS� , <br /> Applicant To Complete This Porm ���`��.6 <br /> If more than one building is to be constructed, submit a separate permit <br /> application for each Uuilding. A separate permit will be issued for eacli <br /> building. , ,; <br /> r; <br /> / r <br /> Owner , LCCA-2 �,.</� l/l«-r, _h'� IIuilding Address i.l'�., „ �.i<-,:<�- <br /> i . <br /> Address f��� Z %�u;�,_'.�� Lot Block <br /> City i�ti-wc��(� I�hone Subdivision (Plat) <br /> Architect/Engineer <br /> City Phone Metes & Bowids (Onplatted) . <br /> Contractor ��,1���_�ti-�� C �,��.����; (,., Sec. Twp. Rge. <br /> Address %�{ �a � �+- <br /> City �� L��� / Phone 33 7- c/z � L <br /> State License Number ; z '> - �' i C J'�j <br /> Expiration Date <br /> Building Use F`�-""" <br /> , Describe S•7ork L-o Be Done <br /> , , , <br /> 1 v <br /> ���"�'rt.w �-f'-n-t ! -[e.-C�., d� .e,..�,(-a� <br /> i <br /> , <br /> �1"� '�'�-� 2-��it+,•t �-�L c�-✓ <br /> � Nu�ber of Stories ` <br /> i Basement <br /> New Addition ��pairyRemodel <br /> Valuation of Construction $ �/n�-o '- <br /> � Signed IIy ��=,...iL��, , ' ,��j�i<��� <br /> For '� <br /> Owner Phone <br /> _ Do Not �Jrite Below This Line-I'or City Use Only <br /> Date Received • Dse Sone <br /> L�lan Check Number ' Firc 7one <br /> Valuation � °-'�r � � Occupancy Gr.oup <br /> Permit I�'ee Type of Construction • <br /> Plan Check Fee Occupant Load <br /> Total Fee Due Sprinklers Required <br /> Aate Issued <br /> ' r <br />