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�� J.. <br />IIUITDING PGRMIT APPLICATION �/�'� 7� <br />Applicant To Complete This I'orm <br />If more than one building is to be constructed, submit a separate permit <br />apnlication for eacli building. A separate permit will be issued for cacli <br />building. <br />Owner __��Z�? �� j �� <br />Address � //�n_-r slj�rLnr �or.</ G%i�e� <br />City �PiP-�. Phone <br />Architect/�ngi.neer .�'�%r�,v,,-n,��r� _ <br />City Phone <br />Contraci:or /�LI;yY�a��9�it77 ./��,�il� • <br />Address �P_,t� i /_'ir-� � <br />City /v.�iirirT�� Phone g,3�31n9 <br />State License NumUer i�G %ON- �,•i..,A;,�,v„�F <br />Expi.ration llate _ /D- :6 <br />',1 Tdrx ainl�irz✓"" <br />,�- �; fiiiY>r9 RGoF, <br />�r��f�rtJ � ',r . � • <br />. <br />lJ�G�.% i ���- <br />C�-" li � C'?C���i <br />/G�� <br />�4. _ �J n .•��'� <br />�� - -.-_ <br />�r--- / 71 . ' � <br />S� '- <br />}�ii.3,��'x _ --/ <br />i <br />IIui.ldinq Address ���'e � <br />Lot IIlock • <br />SuUdivisi.on (P1aL•) i'��r��i l��i^N/ :b <br />r�//✓. Li�T � /�1i�-E�Yis"/.'O,e�n� Gr�r ay <br />Metes & Bounds (Unplatted) <br />Sec. Twp. Rge. <br />- ,_ rx ���x �a. <br />, <br />� IIuilding Use ,�siiy�ir;Tc. <br />� <br />�i Describe IVork to Be Done �v1 0�•� <br />%� j.� �-r�Slirr� �'..nng ,2onm Clin��/. .+1L?L='� <br />l�rC.t <br />I <br />Number of Stories /r ,fU''�--�%% <br />;� , Basemenk iL/p <br />�I Neta Addition Repair./Ret del <br />v Valuation oi Const�uction $ C'i>>-Y� <br />�, <br />Signed 3y i ,, % +:^� <br />ror ��. ' �� • � "�.:, G <br />� <br />Owncr Phone �j,s-3GC79 <br />Do Not Write I3elo�o 7'his Linc-Por Ci.ty Use Only <br />Datc Reccived /��%�='�f Use Sone �-/"i,v�� �/�!- �a�.% <br />I�lan Check NumUer Pire 7one '� ,�,, <br />Valuation /iLfC- `"`� Occupancy Group <br />Permit ree .�U- E"�� Type of Construction <br />Plan Check Pec � Occupant Load _ _ <br />Total ree Due /C�� �" Spri.ni:lers Required <br />Date Issued _ � G' C' <br />