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� s�.? - i � <br /> . � / � ; <br /> IIUILDING PETtN1IT APPLICI�TION �Zjy�� <br /> Applicant To Complete Tiiis Porm <br /> If more than ot�e building is to be constructed, submit a separate permit <br /> ap�licatiou for each buildin9. A separate permit will Ue issued Lor each <br /> buildi� � Q� <br /> o Bui.ldi.ng F+ddress <br /> Owner � Lot L� Block 1 <br /> Addres� J - ,�, ,����, <br /> �li2�s�g Subdivision (Plat) n /� <br /> City ��— Phone i . �— lN"1 G�� <br /> Architect/ gineer I <br /> ( )i �� n> � c � � <br /> Phone Metes & Bounds (unplatted) <br /> CitY _ � _ R e. <br /> ° Sec. Twp. a <br /> Contrac�or <br /> Address <br /> City S��nu�.,_,.,_�_ Phon ���� - <br /> State 7�icense 13umUer ����-n��_� �'�+�� �--- <br /> Expiration Date c - � -�� — <br /> Bui.ldin9 Use <br /> DescriLe Work to IIe Done <br /> ' �'���sL� �I l't��4--�.� n� � �k0�C1��A_1�a <br /> Number of Stories ___ <br /> Basement, <br /> l�e�v A�idi.tion �:epai� Remodel <br /> 00 <br /> Valuation of Cwist:-uction $��Qd— <br /> g'g iecl' �. . <br /> r�.- - ,� ° <br /> Owner Phone�Y1�`11 I� � <br /> Do D�ot ��'rii:e Below This Line-Por City U^c On� <br /> � Use Sone <br /> Date Received <br /> Plan Check Number <br /> I'ire Zone <br /> Occupancy Group <br /> Val.uation �� � � - <br /> 'Pype of Construction �_ <br /> Permit Pee _ OccupanC Load <br /> Plan Check ree <br /> Sprinlcler.s Required ____,_,_ <br /> Total I'ee Due <br /> DaL-c Issued <br /> --'' <br />