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BUILDING PERP7IT I+PPLICnT20N <br />� � �. .=� �%� <br />��� - �.� <br />Applicant To Complete This I'orm �c� <br />If more than one building is to be constrvcted, submit a separate permit <br />application for each building. A separate permit will be issucd for each <br />building. A <br />Owner D/7 �Ii�yP r Building Address �Z�pf" /,�fAlA/y/� <br />Address �7�/ �tJ�'f�Q�jp�� r,ot 3 ,�' �.'.�Lysio�k �<" <br />City Phone SuUdivision (Plat) Fi;�LCni✓t�,('s <br />Architect/Engineer � fj/�' /} <br />City Phone Metes & IIounds (Unp]$�ted) <br />Contractor /r//,�i��j Cp�� Sec. Twp. � Rge. <br />Address Rj✓t�xOl�D S/✓0�1/�A�/j/j <br />City Phone��/� � <br />State License Number �}. �}� p/„ /� fi�r <br />�'0 7 <br />Bxpiration Date 6 �/ +. '� i <br />_ , - IIuilding Use Q/,�I�l./.�� <br />Describe IJork to IIe Done <br />wo�P/�1' o � rou•v/�r,�.c�J <br />Do Not P:ritc <br />Date Received <br />l�lan Check Num <br />valuation ��C'J�c^ cJ <br />Per.mit Fec �� <br />Plan Checl: Fee <br />Total Fee Due �,7 . �T�i <br />nate zssued J�z?� <br />Number of Stories � <br />Basement /�(> <br />New Addition Repai�Rq�ctdel <br />Valuation of. Const�uction $ O 6 <br />Signed By � <br />For ���yl� � � <br />Ovmer Phones�� � <br />Line-For City Use Onl <br />Use Sone —� (�7-- <br />I'ire 7.one �'� <br />Occupancy Group _ <br />Type of Construction <br />Occupant Load <br />Sprinl:lers Required <br />