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IIUILDING PERAfIT AI�PLICATION <br /> Appl.icant To Complete This Porm <br /> If: more lhan one building is to be constructed, ;ubmit a separate pertnit <br /> app].ication for each building. A separate permii: will. be issued for each <br /> Uuilding. <br /> Owner � � '> ` 1� i� l, , + `� �-� _ , , <br /> ' ' � Buildinq I�ddress '>; <br /> Address S a// . � . . . . , �� <br /> ''' � Lot IIl.ock <br /> City �_�/,=-, Phone � - Subdivis3.on (Plat) <br /> Architect-/Engineer <br /> City -- __ Phone Dietes & 13ounds (Unplatted) <br /> Contractor - � Sec. T�op. R e. <br /> Address ';� '>�:i ,�r' ,/ �= � g <br /> ' ' �=— <br /> City ' '�, PhOnC . <br /> State License Number <br /> E>:�i.ration Date <br /> , � •. <br /> , � 14uilding Use ,: ,•- <br /> Describe P7or}: to Be Done i , �,� <br /> - - , � <br /> 14umber of Stories <br /> Basement <br /> ` ' I , . Nec:+ Addition (Repai.r/Remodel <br /> � ' ` Valuation of Construction $ ' <br /> � —_— <br /> i <br /> � Signed By ' <br /> Por - • � <br /> . Oomer. Phonr . <br /> `_ Do Not l9rite IIelow This Line-For C3.ty Use Only <br /> bate Received _ • Use Sonc <br /> Pl.an Chec1: Number. ------ Pirc� 7,one <br /> Valuation Occupancy Group <br /> Permil- I'ee Type of Constructi.on <br /> Plan Check 1'ee _ Occupant Load <br /> Total Pec Due _ Sprinlcler:; Rcyuired <br /> Datc Is,�ed �"--'— <br />