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� <br />��//- 7k: <br />DUILDING PERMIT APPLICATION /i� <br />Applicant To Complete This Form ���/�� <br />If more than one building is to be constructed, suUmit a separate permit <br />application for each building. A separate permit �vill be issued for each <br />building. <br />Owner � i" A�-�,,J Buil3ing Address �%i ��;��f'���;;, <br />Address � 7� � .�,x,L� _��c�,� Lot c-_���p Block G,� � <br />City Phone �- � � <br />.e' -rT 5�--3C�sc Subdivision (Plat) ,..p.,��f <br />Architect/13ngineer t�, �„ . �_ j}pt�n,u',,; <br />City �;,��,.`�n-- Phone Metes & Bounds (Unpl.atted) <br />Contractor ,S:��ti�,�. -[�J,{�,�,t=�-� L Sec._ Twp. Rge. <br />Address � (�, �o x ! NC1 <br />City -�� Phon�3�-ai •'-/GiL . <br />Scate r�icense t�umbe�,;���g-- �/ <br />Expiration �ate G��=�/- �� <br />Buildinq Use <br />Describe S9ork to IIe Do�le �r� <br />. iY�7h,l:�n.�r y,_ _ GIt/!IA �. rc/A// <br />—J— <br />NumUer �f Stories i <br />Basement <br />New Additi.on Repair/Remodel <br />Valuat:.ion of Const�uction $�-� <br />� <br />Siqned 13y Lc., Cli' n <br />Por � <br />Owner Phone <br />[�'rite I3elo��� Tiiis Line-For City Use <br />Date Received 20 <br />I�lan Check Nwnbe (o-// � <br />Valuation ��, � <br />Perm.it Fee � �. � <br />Plan Check Fee v � <br />33. & <br />'Potal Fee Due }�s U <br />Date Issued /� f7(p <br />Use Sone <br />I'ir.e Zone <br />Occupancy Group _ <br />Type of ConsL•r.uction <br />Occupant Lo�d <br />Spi-.i.nklers 12equi.red <br />