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IIUILDID:G P]iRh1IT APPLICATION /����� <br />Applicant 'Po Complete This Porm <br />i/a�%� <br />Ii more than one building is to be constructed, suUmit a scpar.ate permit <br />applicat-ion for each buildin9. A separatc permit will be 3.ssued for cach <br />bui.lding. <br />Owner �_ l:� - `�� _'�i� <br />ca" L'L�.�- �'� �>- r� I3uildi�i AddressG c�nc- ' <br />9 ��v :� � J=t> 1' t <br />Addr.ess ��"��^i_ /re-�;=�=-��_,� Lot �J Bloch "��-� <br />City �:��•_. r��� Phone %.% f,�..;j,j Subdivision (Plnt) <br />nrchitecL-/L•'nqineer �r, .`: �; ] L�� � y�: <br />— 1_a�_ z' 1,� ���, L<y y. <br />Cii�y Phone -, 1•fetes & 13ounds (Un�latL-ed) <br />ConLractor,.�� �`��'d,-. �' C i. , <br />�_ .�n-� �..� Sec. Pwp. R c. <br />Tddress �,��7�/ G� �. �-- -- - g -- <br />c--1�=.���� ,�� <br />City �«<-..<c��� Phone�✓ d�.�iJ"�,1 <br />Stzite�License Number '>�J;3n/- i,I'�_,�T <br />Lxpiration Date • � -� �' - ----- <br />_ Do Not iVr�te 13cloio <br />nate RecciveQ _�� q���__ <br />r--r <br />Plan Chcc}: Number ��-' •7(� /��/a _ <br />Val.uacion _?�4����.4>^t-' <br />Pern�it I'ee (���f , ��' <br />P1an Checic P'ce �_ , !�z� <br />Total Pee fJue <br />Datc Is ,ucd --- <br />i3uilding Use ; ��.�_ ,_�'p_�; <br />Describe f•7or}: to I:e llon� <br />���' c: �c'r° ,�.-_� cc r ���. <br />-. <br />Number of Stori.es � <br />Aasr,menL- �--- <br />l:ew Additio�t Rc��air/Remodel <br />ValuaY.ion of Const�uction $.�.�1r_cc <br />Signed II}> <br />I' o.r <br />O��m er <br />> 1' " " ' <br /><c G'L;c_.- C�-�'�.�t-�-��" <br />Phone 7.f1� �,� � <br />is Li.nc-For CiL-y IIsc Only <br />Usc Sonc �- ���t.�� n_ �_ � <br />I' � � `l-�_ �e�� <br />F.ire 7,o�:e __ 3 _�`-- <br />Occupancy Group � <br />'I'ype of Construction _����� <br />Occu1�ant Load <br />Spr.inl;lcrs Required <br />CIT`r n� E1'cRrTT <br />APPROV[D FOR BUII_Dli\'G F'GR��IT <br />Dato-L��_1 ._'_.__f3y , <br />