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-, r �- i� <br /> IIUILDIDIG PEItMIT APPLICA`PION . ' � S� <br /> Applicant To Complete This Porn. `?�s��� <br /> If more than one Uuilding is� to be constructed, s�.;bmit a separat:e permit <br /> application f:or each building. A �eparate permit �ai.11 be issued for cach <br /> building. � <br /> Owner � � J IIuilding �ddress '�/ / y �q.(L�; �QtJ� <br /> Address '�j /4 �11J.�C f � �P Lot� iy,� ,�y_tj Z� IIlock .Z'3 �j <br /> City �i lU,-cu�Zl_"" Phone��� SubdivisiF� (Plat) � u..o _�� <br /> 7lrchitectj�ngineer j 1taSr�c (Y��q ��1� . �1 l..y�.�7— <br /> City Phone Metes & Bowld:, (Unplatted) <br /> Contracior �y �_� �� f'�.�(.,RA-Q C4� �n�"- Sec. Tc,�p. _ Rqe. <br /> Address I�- r �R.� 3 �`+ — <br /> City �� "'��` Phone c%3 i=USie� <br /> r <br /> State License NumUer 2 Z � -.�i - /S�C�3 / <br /> Expiration Date ����Z <br /> Buildiny Use �� ��L i <br /> Describe [4or}; to IIe Done , �-y. <br /> WAS:�S . �[.�.d-�I .(1tiL�-av ��c'cdlt,c6.�'� <br /> � ��L�' C `�( �1.� L��M �- <br /> Number of Stories �R� <br /> Basement /�� <br /> Neca Addition Repai,�cmodel <br /> Valuation of Constru ti $��� <br /> _ _ � <br /> Signe�l—f33p-- � � ' <br /> I'or � <br /> � <br /> Owner one �_ <br /> � ' • <br /> Do rot t4rite IIelow 'Chis Line-L•'or City Use Only <br /> Date Received �j/S�7C,o • Use Sone <br /> T� <br /> Itlan Check NumUer 1�ire 7,one <br /> Valuation �C9�0• �"= Occupancy �Group <br /> Permit Pee �q` �� Type of Construction • <br /> Plan Check I'ee Occupant Load <br /> � O-v <br /> Total I'ee Due �=-9 " Sprinklers Requa.red <br /> Date Issued 2���J �a <br /> � <br />