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. //- i- '7� _ _ <br /> � ��,vv�-,u� /g(,5.�-- <br /> BUILDING PliRh1IT nPPLIC71T20N <br /> App.licant To Complete This I'orm =3 `i/ i� <br /> If more Cltan one building is to Ue constructed, submit a separate permil/= '� j <br /> <i��plication for each building. A separate permiC will be issued for each <br /> 1rJ I I ^.; rcr. •. <br /> O�an>r 7 � �iq � Duilding Address �< �c� �� r <br /> � / fi l/ <br /> Addres� � � <br /> eJ. Lot �(„ II].ock <br /> City � Phoiie "�� Subdivision (Plat) /�;irr i?�irY �� <br /> Arcl�itect/ ngineer �� <br /> City � Phone ' Atetes & I3ounds (Unp].atted) <br /> Contract:or � �� ��Q� Sec. Twp, ��9�, <br /> Addr s �(n �C <br /> City��,�Qhq� _ Plion :7�7�l� <br /> State License t•:u:nbera��j ��' ��.1�� <br /> �r,piration Date �- � - �'L� _ � <br /> Tuildi.ng Use <br /> llescribc I�Tork to Be Donc <br /> �°t� � � <br /> , 1�.._ c�_��_• c`��o X I�i� <br /> Number of Stories <br /> F3asement <br /> New Addition Repair/Remodel <br /> Valuation of Construction $��� <br /> S i,,t3 n ed <br /> Por�� '�(\ nl��l� <br /> Oemer Phone`�� <br /> Do Noi. I9rite 13elo;a `.Chis Line-Por Ci_ty Use Only <br /> Date P.eceived _ _ -� c 7/� ` • Use Sone ���--��,e,S�c �'��y,,� �p�,� <br /> Plan Checkp�ldumber 7 �-/�Z rirc Zone y�'� <br /> Valuc�tio�i"' ��� o C� Occupancy Group � <br /> Pennit I'ee Z9. � Type of Consi:ruction � , � <br /> Plan Chec}: Pee '/Z•'``� ___ Occup�aiit Load <br /> Total I'ee Due �(�. �� Sprinlclrrs Required <br /> balc Is�u�3 <br /> ��---— <br /> cirv or- EVEaer.r <br /> APPF20VED FOR E3UILDING PERMII <br /> llale;-�:-'--�_ __ __8y��6'�..._--,�. <br />