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�~I <br /> J <br /> i <br /> i, <br /> i <br /> . , • DUILDING PERh�IT APPLICA'PION . � � 3�- /� j <br /> ' nPP�icant To Comp].etc 7`his 1'orm ' s,� 5� ', <br /> If more than one building i.^,' to be const•ructcd , submit a separ��te pe/nfi.t �6 <br /> �PPlic•aLion for each building. A �eparate pelmit �oi.11 be is:,ucd for cach I <br /> Uuilding. � <br /> Owner _S � ��l�a �js Building Address I <br /> Address �;a- ;o � F-,h. �Pa+., c( �t/�� �. Lot �` �d� � 131oc1: � <br /> City �,1 � r! , � Phone ,1 �2 � ,'7%�/ Subdiyision (Plat) • � <br /> Archi�ect/Engineer �o-H �y - l �-/�` „�e_.� ,r,�n �>%h � <br /> Cit Phone Metes s IIounds (Unplatt�d) <br /> Contrci•or -f-own; Y �w-�/-/y� ��� �'N�. Sec. ' T�op. Rge. I <br /> Addr��s � y l J .. ��. ! �- Su%. <br /> City �!/,r/h(r,J�a(_ Phone 77� - zrY�. • � � <br /> State License Number 3 � 3 c� �• 3F�•� <br /> Er.piration Date � <br /> , . - � . Building Use ' �-E' S I'I <br /> ' Describe S•7or): to Be Done <br /> ' � o <br /> COhP?._::�. PLOT PLA17 C�T ItEV�RSE SIIi� � % '� �� <br /> Number oP Storicsi <br /> � � Basement <br /> ' . ' " tde�•� I�ddition Repair./Remodel� , <br /> ' � � . � � � ..r. <br /> ' , . _ _ • . Valuation of Construct•ion $ �oo — ii <br />., . . . ,� . <br /> . • �1 F� e- <br /> • , , . , Signed IIy o�G.. ' �!� <br /> � � � . . Fo� s� /�s ,�1��.ib� . <br /> . � Owner • Phone •� C :�. � <br /> • Do t�ot ��;ritc Belota This Line -ror City Use Only ' <br /> �Date Received ' ' ' ' ' • � ilse Sone ' • <br /> 131an C;�ec): Number ' • Firc: 2one <br /> Valuation ' • Occupancy -Group <br />� Pernit Fee • Type of Con.sL•ruction " <br /> Plan Cl�eck ree ' Occupant Load <br /> Total 1'ee Due SprinJclers Required <br /> Datc Issued � � . <br /> , . . . • <br />� <br /> -- �-�-- <br />