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BUILDING PERMIT APPLICnTION <br />Applicant To Complete This Form <br />If more than one building is to be consiructed, submit a separate permit <br />application for each building. A separate permit will be issued for eacl� <br />building. <br />Owner wN�, �' f�p,�t Building Address �C1 ZU �v�,r7- <br />Address ZCLzn {.��� �-�-T- Lot Block <br />City Phone Subdivision (Plat) <br />Architect/Engineer <br />City Phone Dtetes & IIounds (Unplatted) <br />Contractor �S�L,� Sec. Twp. Rge. <br />Address <br />City Pilone <br />State License Number <br />Expiration Date <br />Building Use <br />Describe ��ork to Be Done <br />G o ��e-p 3 C� ` ` .r � �- <br />Number of Stories <br />Basement <br />New Addition �pair/Remodel <br />Valuation of Construction $ <br />`�bC`� • �9� <br />Sign d IIy <br />Fo�' _ <br />Owner Phone <br />iL•e Below This Line-I'or City Use On <br />Date Received ��13 �-Z lP <br />L�lan Check Number r— <br />Valuation '—�9' �00•�' <br />Permit I'ee �• �" <br />Plan Check Pee <br />Total F'ee Due �S �� <br />Date Issued / // 3/'Z � <br />Use Sone <br />Fire Zone <br />Occupancy Group _ <br />Type oi Construction <br />Occupant Load <br />Sprinklers Required <br />