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��'.�_ � � <br /> ' I3UILDING PERMIT APPLICATIOW . • <br /> Applicant To Complete This, 1 orm ' �� 3���� <br /> If more than one bui.lding i,� to be consirncted, submi� a sep�r.ate per.mi.i: <br /> applicalion for cach Uuilding. A separatc: per.mii� wi.11 be issue<1 for each <br /> building. (� � <br /> 0�•rncr �s- r `�Y 2�c IIui..ldinq Address /'�oz he � �c <br /> ! <br /> Address 2 /� � Lot 3 3- 3� 131oc): 2 5'X - S o� <br /> City �' Phone /�/_�_, Subdivision (Plat) �Y� /�i 4, / <br /> Archi',:ect/Engineer ,�f � y 3 87- �,i 8= 0 33 - o 0 00 . <br /> City Pho/qe Metes, h 13ounds (UnplaLLed) <br /> Contract-or !, � (.�>�1 r� Sec. 'Pivp. Rge. <br /> Aildress � e /`c � _ <br /> City S� . � Phone �?f�-�o s'� ' <br /> SCate License t�u�nber �2 3 -� / - S'(S�a <br /> Expir.ation Date �� <br /> IIuilding Use ��es: �,,�< _ <br /> Desciibe Ylor!: i:q�13e Done <br /> � �Q. - � �.. c���� <br /> C,�1��L�'TE' PiOT PLAId ON P�;�I�T�E SIPE <br /> Numl�er oi- Stories ` <br /> Basement � _ _ <br /> ' Nea� Additi.on Repai.r./Remodel' <br /> valuation of- Construct-ion $ 7�v' <br /> . Signed II � ✓ , <br /> ' For � � <br /> Owner Phone C u-i��� <br /> Do t`oL• [�rite 13e1o�•; Tltis 7ine-I'or City Use Only <br /> uate r.eceived 2 7 • vse Sone <br /> I�lan Chec}: Number ��' rirc 7,one <br /> csy <br /> Valuation 2����� ' Occupancy •Group - _. <br /> Permit ree g�- �-� Type of Const�'uct-ion ' <br /> l�.lan Check Fee OccupanL- Lo<�d _ <br /> ToLal Pee Due �.'��- Sprinlclers P.equi.r.ed <br /> Dai:c Issuea 'Z �P/7C�> ' <br />