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13llI7,DING PEltt�iIT APPLICATION !`�`' <br />nPPlicant To Compl.etc This Porm =/�/7,c: <br />If more than one bui.lding is Co be construci:ed, suUmit a separate permit <br />appli.cation �or each Uuilding. A separat^_ permii: will be issucd f.or. eaclt <br />building. ' <br />� � C�/zc� /1'.�/✓}iuilding nddress :�.��.,i� ��.c �.i,;�..:,;; _ <br />Owner / �%.�t i°- 5F'�� � . Z � <br />nddress �002 �uC/�•=�'� � �� <br />Lot / 7' 2� I31oc}: � <br />' ugc � Subdivision (Plat) ���� � <br />City �=�_ Phone �� r <br />Architect/L'ngineer _�_ — — <br />City ___ Phone t�ietes & 33ounds (Unplatt�d) <br />c�,. Sec. Twp. I;ge. <br />ContracCor �•—L� <br />Address �1���� <br />City Phone <br />State License humber <br />Lxpiration Date <br />— � <br />IIuilding Use �/�F��C�N�' /^� <br />DescriUc �9or}: to IIe llone <br />(' ,� ,z �',�� '� i3+an,� e � r3� i�� . <br />Number of- Stories�/ � -- <br />IIasement / <br />Nr-_�a Addition Repair./Rc:model <br />Valuati.on of Construction $ �/5`_`� <br />Signed IIy � . �n-�'—'-' <br />J <br />1 Ol <br />owner Phc.�e _ _ <br />Do Not ta.rite 13eloar This Line-I'or City Use Only _ <br />Date Feceived • Ose Sone <br />I�lan Chcck NumUer 1 irc 7one <br />Valuation Occupancy Group <br />Yermit Fcc _ Type of Con�truci:ion �— <br />Plan Check Pee Occupant Load -- <br />ToLal Yee Due <br />� Eprin}:1eLs I:e,qui-r.ed �_— <br />Datc Issue_1 <br />