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IlUILDING PL'RtdIT APPLICATION <br />Applicant 'Po Complete This Form <br />If more than one building is to be constructed, suUmit <br />z lication for each buildi.ng. A separate permit will <br /><PP <br />Uuilding. <br />X Owner � l,✓- 6� ��� i <br />Address ;23/ � �Uc lyi� � <br />city 1- , i•- i' ! Phone ,;�5�.�- :�'Y� G <br />nrchitect/�ngineer �- <br />City <br />Phone <br />ConLractor Jo ; !3 . �don` � <br />Addrecs %d �`� "�-'� <br />Cit}, �p�,,�¢ = nl,onc�-i-�"S3 / <br />Stai-e License NumUerlZ�Q/-Soi�Fj •�v <br />�� <br />Exriration Date � / - % ( <br />/° ° <br />,-i� �� <br />�/.� ��i�.� <br />a separate permit <br />be issued for cach <br />Building Adc�ress l p��,—���'f�'� ",1 <br />�,ot z�-1 ��o�r .��� � ,, <br />SuUdivi.sion (Plat) ,��=�=_-`_�e�. <br />��--:c — <br />P7etes & Bounds (Unptatt.ed) ___ <br />Scc. Twp. Rge. <br />Buildiny Lse � /_c�t,::��� <br />Desc � e I4ork �to /IIe� Do�ie - �� <br />_�G:-Lc..�v'�-e�-..� _ f . (ni'�y`".. <br />/ <br />14umber of Stories _f __ <br />Basement ���� ( � _ <br />New Addition Repair./Reinodel <br />Valuation of Coa� uction $ <br />.!_-� ���Y'"__ - <br />l Signed i3y .., — %J ��i� ... <br />n �— � J <br />Por L/� �e��—_��� ✓��v �� <br />Owner Phone ' i- _ <br />Do `'ot t'.r.ite Pcl_�tv '.Chis L.inc-For Ci.ty Use Only <br />Dal-e Received _ Use Sone - <br />i�lan Check Number <br />Valuation <br />Permit- ree <br />Plan Check Pee <br />Total Pec Due <br />Datc ISsucd <br />Pirc Zone — -- <br />Occupancy Group _ _ <br />Type of Construction _ <br />Occupant Load — <br />Spri.nlcicrs I:equi.red _ _ <br />