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..:r.- •.-._ <br /> ' IIUILDING PERMIT APPLICnTION <br /> �;.�°;� ` . � Applicant To Complete This Porm <br /> r;�'° ' , If more than one building is to be constructed, submit a separate permit <br /> � application for each bui].ding. A separatc permit will be issucd f.or each <br /> � building. <br /> Owner _�/� r�, - � ,.� / Building Address <br /> Address /�,�� �y�, i7�/ Lot Block <br /> City �i��.�� � Phone � "� c . �'�� <br /> — i �- -�� . Subdivision (Plat) <br /> Architect/Enqineer �--- <br /> City �_ Phone Metes & Bounds (Uiiplatted) <br /> Contractor � �..,,� � ���, � �_,/� Sec. �pW <br /> /_, P• Rge. <br /> Address�{ 1";� X ,Y�/`� <br /> City �/a., /,' �%% Phone /^:-'_ `i'' " <br /> State License Number �,��� - � �._:--r,,� <br /> Expiration Date <br /> IIuilding Use ,L�,._, �, <br /> Describe S9ork to Be Done V;•�� <br /> / J <br /> I �•�✓/!,` <br /> Number of Stories <br /> Basemen� <br /> New Addition Repair/Remodel <br /> Valuation of Construction $ .��_= <br /> Signed DY �����1 .-;�. , ,� <br /> Por � <br /> Owner Phone <br /> Do N t Write IIelow This Line-Por City Use Onl <br /> Date Received / /Y 7� Use Sone <br /> If].an Check Number — Pire Zone <br /> Valuation 5�. �" Occupancy Group <br /> Permit ree ,?� � , �U <br /> Type of Construction <br /> P1an Check Pee Occupant Load <br /> Tota1 I'ee Due �z � `� �-- <br /> _ Sprinklers Required <br /> Date Issued /� '? • <br /> — � / <br /> � � 6 - 7Co <br />