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�/ � �. <br />• , • IIUILDING P]'sRt•fIT APPLICA'PION • =��°�� ��' . <br />. 1 � `sr <br />• ApplicanL• To Comp].eL-c 7'hi..^.. 1'or.m ' /��/l <br />If more than onc bui.ldi.ng z,'L-o Ue constructed, suUmit a separ.��te pc��mi.t <br />applic•ation for. eacli building. A separate pe�:mit ���5.1.1. be is_ ucd for. cach <br />building. �! �. <br />O��ncr r �� ,/ 1' �� � Building Address !�/ZS 'i� ` � <br />� � ..._,�-..i �.�.�.+'�,n.ap z .i_ �_-. � <br />Address `� ° �1 1.._.,. f. .,� ' 12,�� , ,Qu. <br />2/� �".�'l_ . Lot ��=� T31oc1: l;�, G.. <br />City r� •r..� Phonc ;�-C „� � Subdivision (P1aC) • <br />Archi.ec{:/�ngineer ��� ��� �� / � <br />City - 1� one Metes & IIounds (Unplattc:d) <br />Contrector /, Sec. T�ap. Rq�, <br />AAdre�s � <br />City Phone � <br />State License t�umber � <br />Er.piration Date <br />C01�PT�=� PI,OT PLAi7 03� RETI�ISE SID� <br />� <br />� <br />Building Usc <br />Descr.ibe S•:or?: to �e ll ne <br />p9 %� <br />,/ L�i�L�f� I � � �F <br />-----r- r <br />Numher of Si:ories <br />Basement� <br />A�eta Addition Repai.r./Remodel' <br />Valuation of Construct-ion $� <br />Signed IIy S�=,c. �.�l� �. �.,�G�I.� ��J� / <br />F'Ol C � • <br />Owner Phwie <br />� <br />0 <br />� Do t�ot T•irit-e IIe].ow This Line -Por City Use Or�ly <br />Date Reccived " " " •' " Use Sone ' <br />Iflan Chec); Number ' • Firc �one <br />Valuation ' • Occupancy•Group <br />Pernit Fee • Type of Const:ruc{:ion " <br />Plan Check I'ee ' Occupmrt Load <br />Total l�ee llue Sprinlclers Requir.ed <br />DatC IJJtted <br />� <br />0 <br />