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� .� ISUILDING PIiRMIT TPPL2CA'PION • �-� �`�'6' . � ' <br /> • Ap�ilicanL• To Comp].eL•e 'fhis. l orm � 3�3/s ��� <br /> If more than one buil8ing i.' to Ue constructed, submit a separ.at•e rcr.mi.t <br /> appli=al•ion for. cach builuinq. A scpttrate pci:miL �•�i17. hc i�:ucd for. cach ' <br /> building. . - <br /> � : �. IIuilding Addres� �, •%' % <br /> Owner :: •, "< <br /> '' � � "' I31ocl: "� ' <br /> .r' � <br /> �1df�LE55 � , LOt.�- �r' - <br /> City Phone Subdiyision (P1aL•) `' � -��',� r%'_ .'�� � <br /> ,� ��- �, <br /> .�• <br /> Archi=ect•/Engineer � � <br /> City 1'hone Metes &' IIounds (llnple�i•Lccl) __ <br /> Contrzctor ;7 '//r - � � - Sec. T�vp. _ Rge. <br /> . <br /> Ac7dre-ss - = `-� <br /> Cit �, ' ' _ Phone ' <br /> Y ,.,_,�:�� <br /> State Licease 13umber <br /> Expiration Date <br /> - ' • Building Usc ' <br /> Describe P:or}: to IIe Done ��,f` >�'_ <br /> CO]^YT.�:: PLOT PLAtt Oi� REVGRSE SID:�. • <br /> Number oi- Stories <br /> " . ' . Basement <br /> - • • •' New Addition Repair./Reriodel' <br /> • ,a,. � <br /> Valuation of Con�trucLion $ ��i.,�,= <br /> . . . ' � . , j • <br /> , . � Signed IIy �: - /'�� •` �4 f;=�� <br /> ' . £or <br /> ' Owner � Phone <br /> • � • Do t:ot I4rite IIelow Thi. Linc -I•'or City Use Only <br /> Date Receivcd " " " • -� Use Sone ' ' — <br /> Is7.an Chec1: NumUer ' • Firc 2one �_ <br /> Valuation ' '�� ' n ' • Occupancy •Group . <br /> Pernit Fee • . Typc of Consi:ruction �_ <br /> Plan Clieck Fee ' � Occupant Load <br /> Total 1'ec llue Sprin)cicrs Required �_ <br /> Date Issued � • � <br /> 0 <br />