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''l � �. <br /> ,, � , <br /> IIUILDING PERMIT APPLICATION <br /> Applicant To Complete '.Chis rorm ' ' ;�� <br /> If more than one buildiny is to be constructed, submit a separate permit <br /> application for each Uuilding. A separate permii: will bc issued for each <br /> lwildinq. <br /> Ocaner IIuilding nddress �� i iQn�,n ��� ^ <br /> Address �1 � ° � Lot �� �� � <br /> �� 3 nio��: <br /> City Phone � - "f Subdivision (Plat) �Q�� �� <br /> Architect/ �ngi.neer. <br /> City Phone � Metes & Bounds (Unplatted) <br /> Contractor � ,)Q np �Q�� �0 � .p Sec. Twp. Rge. <br /> nddres� �'�� ?D }1t1�Ot�c1 ���'�/�-,Ill <br /> Ci.tY � ���0 v�t- Plion c���-�1CDI� _ <br /> State License Number �-� {'��-� � �.Z� <br /> Exp.i.r.atio�l Jatc �-���1 -- <br /> I3uilding Use <br /> Describe ATorl; to Bc Donc <br /> � -��r �tR�� �h �1'rnOrQ a Q . <br /> ��- rrocs- t <br /> t�iimbcr of Stories <br /> I�asement <br /> Necv Addition Repair./Remodel <br /> Valuation of Const�uction $ <br /> Si�q ed II _ <br /> ror 1 t �. `(�m r(� <br /> otvner Phone ��(a I <br /> Do Not S•;rite ]3clo�� 7`hi, ],ine-}'or Citx Use Only <br /> llaLe Recci.ved • Use Sone <br /> lslan Check NumUer I'ire Zone � <br /> Valuation � a � Yj1 �O Occupancy Gr.oup <br /> Permit Pee _ Type of Constructi.on <br /> Plan Cl�eck I'cc _ Occupant Load <br /> Total ree Due Sprin):lers Requised <br /> Datc Issucd <br />