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9 Jl_ i � <br /> . /,� <br /> IIUILDING PERMIT APPLICn'PION �/9/7� <br /> Applicant To Complete 'rhis Form <br /> If more t.han one Uuilding is to Ue conctructed, submit a separ.ate permit <br /> appli.cation for each building. A separate permit will be issuen ior each <br /> buildi.ng. <br /> Owner �9t '' C• �Lzrl. 1e1�-� IIuildinq Address � !c}Nt� <br /> Lot iJ IIlock c e 7 <br /> Address �$6%;_ ia2 K�-F 'LL��t4 '— <br /> Cit �, Plione 5�-� �j SuUdivision (Platj .-�` iy,-Z`=,�� <br /> Y �iL�=�— p v. f� <br /> �z:__' _-,—�,}-- <br /> nrchitect%13ngineer — _ <br /> City �__ Phone Pietes & IIounds (Unplatted) <br /> Contractor /iJi45�/ <br /> b�` �� Sec. Ttvp. Rge. <br /> Addsess 7�-q ��� �GV'D — <br /> e.�a�n.�-J7` Phone �^/�Z2 <br /> City �_ — <br /> State License Nwnbei 223 �-+D/�-�8.5�3 <br /> ExpiraCion Dai:e _�_f �S^7� —_ <br /> I3uilding Use ��i3OZex/1�� <br /> �a0 ' DescriUe �4or.k to i3e llonc /,fMy1- <br /> 6�.. � T�1 ���, F�-' t�n!y /�a�J�2—.�a��J <br /> � � c� � � <br /> p �� Num �r o Stories i ,v �- __ <br /> o��L` � � itasement �1Q�� — <br /> � „p,�� �� New Additi.on Repai Remodel <br /> ��.. �_� <br /> �Iv Valuation of Constructi.on $ <br /> � � � <br /> Signed IIy <br /> P'or /��JlS - .Q�''�� <br /> 6wner Phone ,�_2-2- <br /> Do Not ZOr.ite I3elotv 'Phis Line-I'or City Use Orly <br /> Dat-e Feceived <br /> Use So�e --- <br /> I�lan Chec1: NumUer .- <br /> rire 7.one - <br /> Valuation ' 0'-"`� <br /> Occupancy Group <br /> Permit ree 3 ` . '�:.� 'Pype of Construction <br /> Plan Cl�eck Fee <br /> __ Occupant Load — <br /> Toi-al ree Due - Spri.ni:lers Required _ <br /> Dai:c Issued 3 z. . "� r L.• :.� , � � <br /> �j 7 � � G Ni'i'RO`!ED f�0� L'UILDIfdG 1'ERM14 <br /> r��y�_. <br /> pate-_-1---/ - --BY -- <br />