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� BUILDING PERMIT APPLICATION / U � � / <br />. �; Applicant To Complete This Form <br />' 3� ��� <br />If more than one building is to be constructed, submit a separate permit ap- <br />plication Lor eacli building. A separate permit will be issued Eor each build- <br />ing. <br />Owner�/•S /I�V Fi� t_ ✓ � C /rl �,�/ <br />Address /ff23 • 1�.4inrieR <br />Cityt=Yer�c.%� Phone <br />Architect <br />City ?hone <br />Building nddress �i l�'C 3 �41.�r'i�' <br />Lot/7 /� IIlk. ,jG / Sec. <br />1t�p. Rge. � � <br />`� r � <br />Subdivision (Plat} L �����f /il U. /� <br />Metes & Dounds (Unplatted) <br />Contiactor $�MiC Noryr_ �MNrc►`e�ferv * <br />� . <br />�� <br />Address i�cr �y,yd, s��r <br />City�Va fC�t Phone 3s"3' %27i' Building Use <br />6tate License Nu-,iber'p�Io�.3�a/=9GGs� <br />Expiration Date ,i 'O / '- 7 S � <br />DescriUe Ylor}: to rie Done �¢ �QoO/�- � <br />� �Nh Sc,vL--u—Ms�Ti'c <br />i <br />�'i51/� %t f ._cs�.vs.o � <br />Use of riuilding <br />'� New :..AddiCion � R pair/Remodel <br />Valuation of Constructi,on $ �(f �'� <br />PLOT PI.AN <br />Indicate lot size, name of streets, <br />. indicate location and �vidCh of <br />alleys, locaCe proposed and all <br />� � existinq buildin9s, show distances <br />to property lines, show distances <br />beta�een buildings. <br />Lot size x <br />� �Lot area S.F. <br />� Size of llldg. 5.2'.. <br />NumUer of Stories <br />Uasement <br />Use Zone <br />Signed Dy������c..�-:)� L:J.�.."(l�.i� <br />Owner <br />DO NOT WRITE DELO[� TiIIS LINB-FOR CI'PY USD ONLY <br />Date Received � ��� 7 S� Pire Zone <br />Plan Check Number � Typc of Construction <br />Valualion %�t9 - � Occupancy Group <br />Permit Fee �, C9� _ Occupant Load <br />Plan Check Fee Sprinklers Required <br />Total Pce Due �C� � � � <br />Pcrmit NumUcr �.{� L S� � ' <br />�- � : � <br />Uate Issued � ( 7S <br />APPROVED fOR QUILDING P[RMIT <br />D�In _ <br />