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BUILDING PE3MIT-APPLICATION <br />Applicant To Complete This Form <br />If more than one building is to be constructed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />building. //� IIII / <br />awner '} O nl- C� FI h� Building Address W(l Or <V r, � <br />T.ddress .A 4 l 3_-, N c Lot Block <br />City C= c`T-t- Phone Subdivision (Plat.) <br />Architect/Engineer jZ, <br />i -> > <br />City `=`er-T _Phone _�jJ 3 Metes s Bounds (Unplatt:ed) <br />Contractor. _ 1 r�5 O-I--Sm�� V p-Sec. 39 Ttap. A ( 0, Rge. <br />Address ri-d-i 6 C I _ i3e(JIua, r, A•r )„31- 2k) <br />City G- Cer- TF Phone 36':6-- 35�'74 coizvex cF it. S,r. A. or ti4 5k. % of set, 31 <br />State License Number 2V2 O I JOZ T �`1 �J_1 2� 9 G W. M,'1k, kcv sY9o' <br />r <br />Expiration Date -72 I -7 0,0 Fee 15i.i8 <br />r-' F�•�aic W � F� 22'i. ab 1T. • T�z N.!)�Sb j� <br />vJ_F JoS L'c Fr, F z S 3Y'-io1. 11s.o 1-r <br />J6.7 ff 1*k'T. ? 3, <br />Vn 1 al ny Use <br />Describe Work to Be Done <br />New CCU � R�ct IG,J — <br />Number of Stories �. <br />Basement (,your <br />�i Addition Repair/Remodel <br />Valuation of Construction $ � <br />Signed By <br />For <br />Owner Phone <br />Do Not Write Below This Line -For City Use Only <br />Date Received 0 <br />Vlan Check Number <br />valuation <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Date Issues: <br />Use Sone <br />tire 'Lone <br />Occupancy Group _` <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />