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- � j' <br />, L / %l - i� <br />IIUILDING PIiRMIT APPLICATIOI4 ����7E <br />Applicant To Complete This Por.m <br />If more than one building i.s t:o be constructed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />buil.ding. <br />Owner 7',�)� J. /�✓/pf%,:' � IIuilding Address <br />Address �/�'�i'Z ; L!�. r�_. _ _ Lot �dlo• ? Z Bl.ock / � <br />City Phone���9-?�,�' - Sul�division (Plat) <br />Architect/Engineer GL �N,;c �:, ( i;.�,; C�, ' �:: T <br />City Phone tdetes h Bounds (Onplatted) <br />Contractor �_��- Sec. Twp. Rqe. <br />Address <br />City Phone <br />State License Number <br />Expiration nate <br />T3u.ildimf Use <br />Uescribe IVork to IIe Done <br />r%- � �v, �7; ,�°fj;;C'��c <br />' ' ri- ;�ens `icc �. - <br />Number of 5tories <br />IIasement; <br />New Adci�tion Repair./Remodel <br />Valuation of ConsL�uction $ <br />Signed 13y <br />I'or / �J� � 7�.,� � , � <br />Owne . � 1'hone <br />_ _ Do 14ot Write 13clow Thi.:; Linc-Por City Use Onl�_ <br />Datc Rcceived �".�, 7 jl, �_ Use :'one <br />LTlan Check Number — Fire 7.one <br />Valuition /!'G•'Lr'c<�, /�O? Ti� c Orcti��anc?• Groi��� <br />Permit I'ee _=, �=; -6' �' Type of Constructi.on <br />P;.an Check i'ee Occupan`. Load <br />Total ]7c�� Due �'" c'c� c <br />/�h•- Spr.inklcr., l:equired <br />Date Issuc;i �;i ?�7(, <br />