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_' 3-1�- <br />II[12LD2NG PERMIT APPLICA'PION �f <br />Applicant 'Po Compl.ete This I'orm �" �/� � <br />If more than one buildin is to be constructcd submit a e arate � <br />g , s p permiL <br />application Por each Uuildiny. A separatc permit �oill be issued for each <br />building. <br />Owner �J�/`>i; S�v.od�i /1"rr �/ Building Address �.�� : '' r.�; �; �� �ii�� <br />AddIC�Ss �j/ j )(qv�� �, w/� �/ Lot- /� IIloCk Z <br />City Phone Subdivision (Plat) �..,,Y•,/� <br />nrchitect/Bngineer _ �.�r,�/p��� jj�'„ �� _ � <br />City ��e�a�i Phone �j�' Metes & IIounds (Unplatted) <br />Contractor s7�,y� �/e�ie -7� ^��� �.yrr� Sec. Twp. Rqc. <br />Address /3as" /'`'jn�/,se•t <br />city -�t � rl,one 3s3�9zir <br />State License Number y�p-ni -9GL-.r� <br />)3xpixation Date � - /- 7� <br />13uilc3ing Use <br />Describe �9or}: to 13e Donc ,�v�v veo- f <br />�iYl�ool-i Ci4riv�5e ���Sl'.rt� .✓L•-._ <br />�/ SC ��Gti" Wr�/iC�CS'�r �iluu.5t f'!� . u-..i�� <br />Nulnf�ci` o'� 5�{"o'ries ""�� ���u' ` <br />IIasement � -- <br />t�ew Addition gepai,r/Remoc�cl� <br />Valuation of Const�uction $ G�� <br />S ig n ed I3y Lf •'' ��,,,s'( <br />For <br />Owner Phor,e <br />_ Do hot 19rite ]3clow This Linc-For. City Use Onl�__ <br />Date Feceived ��L'-I�'14, • Usc Sone <br />L�lan Chec}: Numbcr Pir� 7one <br />Valuation � , •7 ` �� . �rC� Occupancy Group <br />Permit ree �•Z_. �ti) Type of Co�istruction • <br />Plan Check Fee — Occupant I.oad <br />Total Fee Due � 2. ,i--�) Sprinklcrs Requi.red __ <br />Datc Issued i/� �/� �. <br />r <br />0 <br />