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= 3 y3- �� <br /> v� y °! <br /> IIUILDING PPRMIT APPLIC]�TION <br /> Applicant 'Po Complete This rorm `2/�7� <br /> If more than one building is to be constructed, submit a separai:e permit <br /> applic-.' i �in for �ach building. A separate permit will bc issued for each <br /> building. <br /> �n�'-r �.fdMPS �� SypiJ/� �T� � 9uilding Address ' <br /> L �9�(n �e�LroC: <br /> Address /`J�G ,1�a»�roF -�7 Lot��B..%i/o 131ock ,2$ <br /> City ��„a _ plione �-r�4,�� Subdivision (Plat) O'�l� DiV. � <br /> Architect/Enyinerr 'a� k /��d' <br /> —`-7— <br /> City Phone Metes & IIounds (Unplatted) <br /> Contractor .WA3�i• SrBU//t�yec. Twp. Rge. <br /> Address �3�� ,aevP 1�/r � _ <br /> Ci ty �y��,�f� Phone.�5►''353-�o�i,22 <br /> State License Number Z23 0l /�j 33 'r#�ljy <br /> �xpiration Date ,L-���� _ <br /> ]3uilding Use <br /> Describe j9ork to IIe Done 4 /�Jt�y� <br /> o¢�_GU{'Jea.�..¢✓ /•�'•/Ls�2%/ Gbs,t.,g��rl., ,•d <br /> . ✓--°'_ <br /> �o� ow e��,�,�:�.ly�«'rie�s�,-��[AY/yL�. <br /> r<•ni�r <br /> Number of Stories /- Stns•.�S <br /> Basem=_nt �e xF <br /> ,j�jew Additio�t Repair/Remodel <br /> Valuation of Const�uction $ {,r000°; <br /> Sig;�ed IIy � .� �,7— <br /> Por `_°" S�`"� `o."`"""`� <br /> Oconer Phone �a3-S��/ <br /> ��S».eS �11� .Sr„�/`�iJ'. <br /> Do Not {4rite IIelo�•� This Line-L•'or City Use Only <br /> Uate Recei.ved , % 7 7 • Use Sone <br /> l�lan Check Nwnbe 7� -,,5� _ Pire Zone � <br /> Valuation �_��L'�, �� Occupancy Group � <br /> Permit 1 ee `2_-� - �� Type of Constructi.on \1 -�--� <br /> Plan Check I'ee lq - t�U Occupant Load <br /> Tot-al Pec Due C�'-.�- UZ� S��rinl:lers Reqtiireci _ <br /> Date Issued �' //4 -- - ---_ ___ — aµU <br /> —� -- n�-- <br /> CITY C� E'JERETT 11Wa3d JNIc]llfl� 2lOd 43AOaddY <br /> APPROVED F01; QUILDIt�G PERMIT ,�„1.3�7�3 d0 l.11� <br /> / �� <br /> Date_-�I �i.,--BV ---- <br />