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,7 1 _ �[ <br /> ' 9 <br /> IIUILDING PErD7IT nPPLICATION i <br /> . :'/c� .� /�_. <br /> Applicant '1'o Complete 'Phis Porm <br /> If more than one Uuilding is to be constructed, sLSmit a separate permit <br /> appli.cation for each buil.din9. A separate permit wil7. be :issued L-or each <br /> building. �f <br /> Owner � U ��t /� L n.C-P! I Buildin9 Address �/��� U(Cti�1�y �Y <br /> Address 7/(�I �/ .ij�t �1+ � ,c- r d� '- Lot // I3locic ' <br /> City ��.Q � e� Phone iSS=��7s( Subdivision (Plat) <br /> 1�rchitect/�ngineer .S« ,�_ r �+�����, # / <br /> i <br /> City Phone Dletes & I3ounds (Unplatted) <br /> Contractor S �L,.v, F Sec. Twp. R9c. <br /> nddress � <br /> City ---- _ Phone _ — <br /> State Licens� NumUer __ — <br /> Er.piration Date _ __ - --- <br /> Bui].ding Use ��.;�5 <br /> DescriUe ��or}: to IIc: Done _ <br /> �42��/�-�9�-Q"_' <br /> Number of Stories / <br /> IIusemen�t �/:> <� -.z �� <br /> � I <br /> Neca Addition Repair.�Remod�i <br /> Valuation of: Cwtstruction $ <br /> <-:- ,�. �, �/,o co <br /> Signed I3y "!'_�5:1� �� _ <br /> ror <br /> O�aner Phone �iSS=S/:� <br /> po tdot ;4ri.te 13elow This Linc-Por City Use Only <br /> llatc Received u ? � Use Sone <br /> is]-an Check Number 7L+- l4 7 __ Fire 7one <br /> Valuation ��• `�a Occupancy Group <br /> Permit L•'ee �iU•'E'u Type oi Construci:ion <br /> Plan Check P'ec / Q � Occupant Load <br /> 7'uial ree Due � z- `� Sprinklers Required _ <br /> Date Issued <br />