Laserfiche WebLink
��'/7- /E <br /> IIUILDING PERMIT APPLICATION �� 9 <br /> Applicant To Complete This Forr,: //aG�7,6 <br /> If more than one building is to be n��:,lructed, submit a separate permit <br /> application for eacn building. A separate permit will be issued for each <br /> buildi <br /> Owner �� " � Build' g Address o2.s ��y�� <br /> Address .21 �cP �(�CS Lot�� /� Blonck 90 � <br /> City � Phone .� � � SuUdivision (Plat)C� u�� <br /> Architect/Engineer �,r7y�^� <br /> City P ne � Metes k IIounds (Unplatted) <br /> Contractor �• ' � � <br /> Sec.__Twp. Rge. <br /> Address� <br /> City Phone <br /> State License Number --- <br /> Expirztion �ate <br /> IIuil.ding Use <br /> Describe t �'k to II Do e ._ <br /> r . � <br /> S D � � t ..�,�c�'� <br /> Number of Stories <br /> Basement <br /> New Addition Repair/Remod� <br /> Valuation Con truction S lSQ — <br /> ,� <br /> Signed IIy � <br /> Por <br /> Owner Phone <br /> Do Not t4rite IIelow This Line-Por City Use Only <br /> Date Received • Use Sone <br /> L�lan Check Number P'ire Zone <br /> Valuation _ Occupancy Group <br /> Permit Fee Type of Construction <br /> Plan Check I�'ee Occupant Load <br /> Total Pee Due Spri.nklers Required <br /> Date Issued <br />