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, • IIUILDING PrRMIT APPLxCATION • �G� � �� � � <br /> ' • Ap�ilicanL• To Com��].ele 'll�is 1 orm� � .��� 3���r • <br /> If more than one building i�� L•o Ue constructcd , submit a separ.�i•e per.mi.t <br /> application for cacli building. A sep�rate perniit ���i.l]. be is:ued for. each ' <br /> building. <br /> Owner ��G2i ��'�/,•� y�T IL IIuilding Address <br /> Address �� � 5'- /�oc�r.��� � �✓�'.i1lt Lot I31ocl; _ <br /> City Phonc �� SuUdiyision (Plat) • <br /> Arehi:cci:/Engineer � <br /> City Phore Metes & IIomid� (Unplaci•ecl) <br /> � fir N. T_� Sec. 7tap. _ Rgr. <br /> Contr�ctor 5�„� • �,,�, ���, ' ry,l� � <br /> Addrss /-al�e- S��v-��+5 <br /> City Phone ,3 �y_� ��'� • <br /> State License t3umber ��,� - 0/-/�7�5 <br /> Er.pi:ation Date �1 / 3 � 7� <br /> � , . • Building Usc _ <br /> � ' Describe t•:or}: to Be Done rVcK ,Doof^- <br /> ' �� f��,s — �'dc _�. /„s � '1�«��0 <br /> CO1F7c__ PLOT PLA2d Os`7 REV�RSE SID: • <br /> c���.�w <br /> Number of Stories <br /> � . ' Basement <br /> • . • � " Ne�a � Addition Repai.r./Rema�e1' <br /> . • � � Valuation of Consiruction $ <br /> . . . . . . ' � jSvo °� - <br /> . , , Signed IIy f�_� ���"'�P- <br /> . For <br /> � Owner • Phone <br /> � • Do rot I:ritc llelow Thi� Linc -I'or Ci.ty Use Only � <br /> Date Received �� �7 0 ' ' ' � � � • • Use Sone ' ' <br /> '__'T- <br /> ls3.an C�ecl: Numuer ' • . Firr. 2one <br /> Valuation l �, � "•� ' • Occupancy -Group . <br /> Pernit Fee • / �,- • ��' . Typc of Co�ist:ruci:ion " <br /> Plan Clieck Fee � Occupant Load <br /> Total 1'ec lluc /,�,�. �lJ Sprinlcicrs Required <br /> Datc Issued �'��;�/7,b '. , . <br />