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• < <br /> . ��7 3 � . <br /> • J3UILDING PT•.RIdI'P nPPLICATI01d • � ' <br /> i <br /> • pPplicant To Com��].eL-c �r.iu.s. r•or.m ^/S/�� <br /> i <br /> If mo:e than one bui.l�li.ng i.^,� to be con�tructed, �uUmit• a �epar.at• . ��er.m�.0 <br /> application for each building. n separate ��er.miC wi.11 be issucd fo�- e�1ch <br /> buildir�g. J J/ <br /> Owner ��a 4-+r� /7`u �r i, ��� IIu:ilding nddress s `/J 5� .�1iv�uml.% �� <br /> Address 3 `/ 1 S fr r e� � �v�, . Lot /1� / `+-�_ 131oc]: � _ <br /> City �'yi �-* <br /> Phone SuUdivisi.on (Plat) u c �M r' _ <br /> 77, 4� � 7` s �",� � �+ _ <br /> ArchitecL-/Engincer <br /> City <br /> Phonc t�eter; & I3ounds (Unplattcci) _ . <br /> �'7� '"� Sec. . 'Pa�p. l:qc. <br /> Con`__aci-or �-� / �� h✓-! y —_— <br /> Add*_=5 ZS.� 2- �.o w� r �i t �ti -/ fT r� <br /> City �� Phone_��'3- ''/[,Sy , -- <br /> State License tlumber � x 3 -���' k2- , <br /> Ey,piration Date ' <br /> ' : ' � IIuilding Usc �-1 ?i d-�/'�� '� - <br /> • DescriUe �•7or.1: to IIe none ��• <br /> . �.�i� � �� � i�*ds��'�t n3r�'e f cady"r <br /> co���T^ rr.o� PLnrr o,J PW��sE s� , J, �, �' � /�„ u. �;��.. _ <br /> Nunber of- Si:ories <br /> ' � . I3asement� <br /> • . ' ' . •. � ���.� Addition Repai.r./Remodel' <br /> � Valuation of ConsL-:uction $�,S'�''� <br /> � ' Signed IIy ' ! � .�� t, -�-� . <br /> . ' For - <br /> ' Ot�mer • Phone _�_ <br /> • � • � • Do 1?ot- 1�:ri.te Iiclo��r 'fhis Line -For CiCy Usc Only <br /> - • . ' Use Sone ' <br /> Date Feceived _ <br /> Islan Checl: Number _ ' • Fire 2one <br /> • . Occupancy •Group _ �=-- <br /> Valuation � /`����'��' ' -� • <br /> Permit Fee �� `=� ' <br /> `y Type of Con�truction �_ <br /> Plan Check Fee Occupant Load <br /> Total Fee Due Sprinlc].ers Required �— <br /> ' Date Issued � ' <br />