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' - � ° �- � � <br />IIUILDING P�RMIT APPLICIITION <br />�/o <br />Applicant 'Po Complete This I'orm ��� 3�%� <br />If more than one buildinR is to be constructed, submit a separate permit <br />aPPlication for each Uuildi-ng. A separate permit will be issued for. each <br />building. <br />Owner ,'/7�/;j� �i.i�'f O/Sr�v IIuilding Address �/y�, GVNNc: <br />� <br />Address 9z� �;,.��,d Lot Q,i�. _„ Block /� L <br />City �y«�f/ Phone _ Subdivisi.on (Plat) /?N,�/�� h�<r <br />Architect/Engineer /�, �� z �- �� � � r�' - <br />City Phone _ Metes & IIounds (Unplatteci) <br />Contractor ,$�,�,� k•,v� 7�1�+l���Ne,oY cc Sec. _'Pwp. Rge. __ <br />Addr.ess /3os. �i.v�.s�,,, <br />City �'�t«/y _ Yhone js3� `la�Y <br />State Lice;�se Number �3-0/- 9�cs � _ <br />Erpiration Date s--�- ;i <br />IIuildinq Use ,yr,y�� <br />nescribe �9ork to Be Done <br />/� �/yb� L �iY F�i � <br />Number of Stories <br />Basement <br />New Additi.on Re a'r Remodel <br />Valuation of Construction $%��o <br />�u�._ <br />Siqned By <br />Por <br />Owner <br />�i/i, i�� �_ ?C�i ._ix <br />Do �oL- h'rite Be.low This Line-L'or City Use On <br />Date Fecei�ed ��/lG�%!p <br />I�lan Check Number %!c-// <br />Valuation �t 019Q � <br />Permit ree �JLc'. �'C' <br />Plan Check Pee ��• � <br />2ota1 ree Due 'S4• � <br />D�L•e Issued %-=� 7 <br />Ose Sone <br />Pire Zonc <br />Phone <br />Occupancy Group _ <br />Type of Construction <br />Occupant Load <br />Spr.inl:lers liequirec3 <br />0 <br />