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e <br />e <br />• • Ap�ilic��nL- To Compl.el:e 'fhis rorm ' � � � 3�y�7� <br />If moze than onc building i,'to Ue constructod, submit a separ.al:c per.mi.L• � <br />appli�aL•ion for cach building. A �epsrate �ic�:miL• �ui.11 he i�: ucd for. cach ' <br />buil�ir�g. <br />Owncr (�(t!r I a, �. N-'�'ti % IIuilding Addre�s <br />Address �� ���i; ��!'. � 1 ` Lot I31oc1; <br />City �' �'i ='Y Phonc � Subdivision (Plat) • <br />Archi�cct/Cngineer <br />City Phone Metes & IIounds (Unplatte<I) <br />Contzactor Sec. T�ap. _ Rqe. <br />Address <br />City Phone • <br />State License Number <br />Expiration Date <br />C01PT.t__ PI,OT PLA17 OTi R..�VERS$ SID3 <br />� <br />Building Usc • � <br />Describe S9or): to Be Done <br />'ti ,�tt`-� -. , � , , . ., -. <br />.1:, ',� <br />_ 4-2'� �C=u� �.� � —T Z11 'j-1 -� <br />Number of Stori :s <br />. Basement <br />' ' ' " New Addition Repai.r./Remadel' <br />valuation of Con�trucLion $ <br />� <br />Signed IIy <br />For <br />Owner <br />Phone <br />. .. _ . . . .., . <br />,..;•, • . . .. , . <br />�• Do rot �•:ritc IIeloa: Ti�i.s Linc -I'or City U,e Only <br />Date Received • " " " • - Use Sone ' • <br />lslan C:�eck Number ' • Firr. 2one <br />Valnation � ' • Occiipancy •Group . <br />Pe7rnit Fee • . Typc of Conct•rucL-ion ' <br />Plan Cl�eck ree ' • Occupant Load <br />Total Fec lluc Sprinlclers Required <br />Datc Is�ued • . • <br />