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<br /> ,Fd,�. T3UILDING 3?T'RMIT APPLICATION
<br /> `�� � Applicant 'Po Compl.ete This I'orm
<br /> y,;y'�'
<br /> � � If more than one building is to be constr.ucted, submit a separate pennit
<br /> �c'," applicaL-ion for each bui.lding. A separate permii: will be issued for each
<br /> , ';�;c'; ., ' building.
<br /> � •i'�+<;.4; ..�.
<br /> ��;;-;-"-; Owner /f, E. � �"i=iC L" IIuilding Address H p
<br /> , Y ^ �� ` Address �
<br /> /� / �, dyh,�c� _ Lot g Block �
<br /> City ��.F-���� Plione ,�_�,? . ���� Subdivision (Plat)
<br />, Architect/Engineer i/�c i o 2 ,� A dd i T•a i
<br /> City _ Phone Metes & Bounds (Unplatted) ,
<br /> Contractor �, � G �_p,r, � Sec.__ Twp. Rge.
<br /> ; � .jL, Address S� � :� c" a Y � �� f, w, --
<br /> 9;� w�:.,., --
<br /> �ir; ' City —�-d�C�.Li,�1' Phone ��G-.�l''�q
<br /> r� q ; State :,icen�e Number �.a� n_/799�
<br /> � �� � � L'xpiration Date ��,�
<br /> ti��''�'`' '
<br /> ' IIuilding Use _Ga.CA�
<br /> ' Describe S4ork to Bc� Cone
<br /> Co.v .r-i�oc%�eA� o �C F,�4.C'A�`.r
<br /> Numbcr of Stories �
<br />; IIasement, ,—
<br /> New Addition Repair./Remodel
<br /> Valuation of Const�uction $
<br /> "F�s o 0
<br /> Signed IIy ' �, �.��,Q„�;,
<br /> P'or _,<,'. F-, i`lL6.t�/ _
<br /> Owner. Phor�e ���;�_�,,��
<br /> l •
<br /> Do Not Write Delow This Li.ne-I'or. City Use Only
<br /> Date Received ��/3�� (p Use Sone
<br /> l�lan Check tdmnUer P'ir.e 7one 3
<br /> Valuation ��r'� � `� Occupancy Group �
<br /> PermiL iee �� - ��U Type of Construction u- t..1
<br /> Plan Check Pee OccupanL- 7.oad
<br /> Total Pee Due ��j• �yv Sprinklcrs Itequired
<br /> Dzi:e: Issued �3,�7CC
<br /> C�T'f C'. ^ - .=?T
<br /> APPROVED FOi; L'UILUIiJG f'ERh111�
<br /> ��te � � ��, Qy_IL. c ,
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