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aJ� <br />13UII.DING PERhiTT APPI�ZCATION �/9/�/ <br />X� <br />Applicant To Complete 'J'his rorm <br />If more Chan one Uui.lding is to be constructed, submit a separate permit <br />application for each building. A separatc per.mi.t will Ue issued for each <br />building. )r,� Qn�.j �;%� <br />Ocaner 1��.iPri � '�;���!_�� 1�uildin9 7+�9druss _.h-a�" ��i�i1f i,/ <br />Address /So> >�;C UCi�9'�J!_/- _ LOt$ Po2'(v��A1.Block 3i� <br />^ity /-'�i�� r�,f Phone ,l;y-�:s") SuUdivision (Piat) ��� i°y���_< <br />�� <br />i�rchitect/Engiiteer �i ia��^� . ___ <br />City _ Phone Metcs & I3ounds (Un��latied) <br />Contractor S'TOc/Crr (_;, �� f Sec. Twg. Rge. <br />Address ln� ��n lKv�- S / — <br />City Sqa�;� ,/c+nlj�_ Phone .j ( � J��j' _ <br />State Liccase Number ;L�.3- i'i - /e4/� _—. <br />Pxpiration llatc _'�-���� ___ <br />n� <br />Date Reccivcd <br />lslan Gieck NumUer <br />Va].uaY.ion <br />Permi.t I'ee <br />Plan Chec)c Pcc <br />Total I'ec Due <br />DaLe Issucd <br />1�'ritc ]3elo�a <br />l�uilding Dse ��;,���<_ <br />llescriUc Z•:ork to IIe Done <br />.V �: ��,..� .�=� „.� �� iJ j„i, <br />Number of Stories � _ <br />Basemen� �'� � ____ <br />New Addi.tion Repair/Remod�l <br />Valiiation of ConsCruction $/: n�' <br />, <br />Signed By ,��� -�t�._- �k�- <br />Por _ <br />Owner <br />is I.�ine-ro: Ci-L-y Use On <br />Pitone ;�,:",1' - - �� �' <br />use sone __ <br />Pirc Zone j <br />Occu1�ancy Gr.oup __�____ <br />Typc oi Construction � � rl <br />Occupant Load _ <br />Sprinl:l.^_rs Requi.red _ <br />CITY OF [Vf_RETT <br />FlPPROVED POR �UILDING PERNiir <br />n�te..1�S_/]4, !3y_����_..�..._ <br />0 <br />