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� 16863 ..., ._ �:�-;.� <br />� ,,-. <br />IIUILDING P�R1�1IT APPLICATION �' I a' 3 �"��� <br />Applicant To Compl.ete 'J'his P'orm ��� `�"""" "'�'`' <br />IL more i�han one bui].ding is to be constructed, submit a separate permit <br />appl.ication for each building. A separate permit �•�ill be issued for each <br />buildiny� <br />Owner � � IIuildinq Address _ _ <br />Addres Lot �l\ ���__ IIlocl: <br />City ��Q}1�� hun�' y���� Subdivision (P1aL-) -- <br />Architect � nqineer ��c, l., - ��R - C�5 _ <br />City P e Metes & IIounds (Unplatteci) <br />Contractor � ' ,-�� Sec. Twp. Rye. <br />Addre � �A <br />City 1.�2�_��x�c _ Pho 3.�]�`1 �\ � <br />State License NumUer j;l'• � _ <br />Expiration llate _ . <br />IIuildinq Use <br />Describe i0ork to IIe Done �sLQ� <br />��c�o.�.,�.l�sl ���ne,�.l^m <br />�S- <br />Number of Stories <br />Basement _ <br />New :+ddition Repair./Remodel <br />ValuaCion of Construct-ion $ <br />S' e y <br />� <br />For ; �`����tr �n�_ <br />Owner Phone �� - � � <br />Do Not R'r.ite IIelow This Line-Por City Use On.ly <br />Date Received <br />L�lan Check Number <br />Valuation ` ��. CJ� _ <br />Permit Pee <br />Plan Check Pee <br />Total Pee Due <br />DaCe Issued <br />Use Sone <br />P'ire 'Lone _, <br />Occupancy Group <br />Type oi Construction _ _ <br />Occupant Luad <br />Sprinkl.ers Required <br />