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• � ' IIUILDT.NG PrRAfI'P APPLICATIOt7 • /�,�Q'- 76 •` '
<br /> ' App.lic,�nt '1'o Com��a.eCc 'Phi.s 1 or.m (od23 �
<br /> If more than one bui.ldi.ng i.^,' to be conctructed ; Y��3�j6 '
<br /> applic�t•ion for cach buildzn n � . � ubmit a separ.nt]e p�rmi.t
<br /> buildir�g. �• �cPtirate 1>c��»�iL wi.l.l bc SJJUCCj f-or c,zch
<br /> ` 79 oz
<br /> ,
<br /> Owner ��F�v;,,�ii �= ' ` � �i� � , IIu•ildinr A �� � '
<br /> Addr.ess , � . J ddres..
<br /> �;• r ' �2�7- !g 7.c;S �J/i!/•'"�-
<br /> r -'� i ' - / l /��'/.^ ' �i'
<br /> . Lot /7 r-��_ '13 ocl•
<br /> City .��- ', - Phone � ', '�, ; � Subd.ivisi.on (Pl�zt) r ---
<br /> Architect-/Engincer � -� �
<br /> , ,' . � , , , ,
<br /> City �,;�_ ; .• �_�_ Phone „' ,3?-G,'�/' Metes t. 13ound.� (Unpl�itCccl
<br /> ContracL-or : -,
<br /> � � ✓Y� :��.i .i -/ . . ,
<br /> � , - �y� <- ,� Sec: Twp, .
<br /> kc.drt-ss j ' �i' .�/ ..�, � ,�� I�c7c.
<br /> .�c �:�
<br /> Clty :- G" � ... P�]OAC � �' .. ._`, �--> ., -
<br /> Statc License t;umber ' � ^_ ,�/ ,,_,,�, • � --
<br /> ,,;��
<br /> Er.piration Dai-e � --•
<br /> — �_
<br /> Duilding Usc �� �//%�- �y/ -
<br /> �
<br /> ' Descr.ibe {•7or.1: to ]3e Done '
<br /> CO;PL„' FLC4 PiS1i Q;1 RECS?�E SID� �'i �.
<br /> ..�.� •
<br /> i� ' /� t�'umbcr of SL-ories
<br /> �,..� � r� , ; �� , �
<br /> .� --- � Basement: +'
<br /> � " Netc Addition Repa.i.r./l:cmodel'
<br /> � Valuation of: Con:iructi.on $
<br /> - -, .; .
<br /> • ' � ' Signed IIy
<br /> For �' - ' ,- �r` --` .
<br /> . .�` ,` �
<br /> . . Otaner • Phone , --`' i ,-
<br /> -- ' Do 1`oL- P;ri.te Relo�;+ 'Pli.is r�i.ne -ro,- c;.ty u,c Only
<br /> Date Reccived J Z 4; 'j �, . . . . . . . --
<br /> • Use Sone
<br /> 7.T1anChec?: i,ur,iber '7�, -2/� . --
<br /> _=_ rirc� 7,one
<br /> Valu:tion � 2C�c�, 1�t7�� �"� .
<br /> � Occupnncy •Group
<br /> , Pcrr;it 1'ec C� ?,,`--,_ �;�-'
<br /> - Type of Con;tr.uci:ion
<br /> Ylan Check I'ee � �-•Z 2 J --�--- �
<br /> Occupant 7 o�Zd
<br /> Total Pcc Due G^ � y . 7, o Sprin):1crs Itequired
<br /> n�,t:� r5:;���a ._
<br />
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