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� <br /> , • DUILDING P3iRMIT APPLICATION • .� �� 7C � • <br /> � • Ap�licattL- To Com l.et•e 'Rhis Form� ��� . <br /> P . � ,�/•'��-� <br /> If mo:e than onc building i,' to be constructod, submit a separ.��te Per.mi.t• ' <br /> appli:ation for cacli building. )1 �cpsrat•e pcimil �ai.11 bc i�.ucd L-or. cacli • <br /> building. ., �� .--__ <br /> Owner i • . _ :_ ,• l; �-, I G... : �, IIuildinq Addre�s._:�',�.�� �- ��-,-.,,1 <br /> � <br /> .'=--" -:� ,. <br /> Address � ' ,' I�� , •�1 {:�u e Lot � .'� °.� I31oc1: �X� <br /> City '=-���.�� Phone --'; _� . �''�` `' Subdivision (Plat) ��1,�; :i..iJ •J�.�� � <br /> . n.�'b�r_..-.,-V�_.�:k.-'/ � �" �v3�� ���'� �1�� �W. �'� <br /> Arehi�tct/�ngineer '�' <br /> City 'L����;I� Phone Metes & IIow�ds (Unpl�ittecl) <br /> Contrector � .•� 1 Sec. 7tap. Rqe. • <br /> Addre=s �'��, � <br /> City . Phone • ._ <br /> State Licease t4umber <br /> Er,piration Date <br /> � • • Building Use • ' <br /> � Describe T•;or}: to Be Done �-.. - <br /> � o �� .-�: :� ,�-,��, �,�,� <.. :��� >:..: .� <br /> COI^PT.,_=: PI,OT PLA11 0?� REVERSE SID.�. � • � . ' <br /> �,_ R.�..�•� , "�?���_ .. S-..�� Z �o... (� <br /> ' N.umber of Stories � <br /> . ' . Basement "�^ <br /> , <br /> - . � ' � " Neta � I�ddition Repair./Remodel' <br /> . • ' •_ , . Valuation of Construction $ 5�v _ <br /> _ .. . Si ned II � � �-YlG IC,.-�a--, <br /> 4 Y `�� ._ _�_ <br /> . . For ✓ <br /> � Owner • Phone•=�= • �`'s'� <br /> � Do t�ot �4ritc Deloto This Linc -I'or City Use Only <br /> Date Reccived �I, ��'1�-7 �' ' � � � � � llse Sone ' • <br /> , - <br /> 1Tlan C:�ecl: Number '—' ' • . Firc: 2one <br /> Valuation �>�. °`" ' • Occupanay •Group . <br /> Pernit Fee f,�. ��� . Typc of Con�iruci:ion ' <br /> Plan Check ree ;---- • Occupant Load <br /> Total 1'ec lluc �, � � Sprinlcicrs Requircd <br /> Datc IJJUC� ����9 Y • , . <br /> • • � • � � • • • <br />