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• . . �. <br />. • DUILDING PrRMIT APPLICA'PION •. /� % ` • <br />, � li� <br />' nPPlicant• To Compl.etc .^hi:.,, 1 orm ' ,!, <br />: If mo:e than onc building i,�to be con�tructed, submit a scpar.��te per.mi.t <br />application for each building. A separate periniL �•�i.11 be is; i�ed fo�� eacli • <br />buil�ing./� �/ <br />OYrner (�/.�i�o i � � V �/ • BUi1�S.I�� /I��LCJJ /Q�/✓� � ��/-� <br />l��dr_ss � �� r '7� �C�.4 �iv �c. v' Lot .? r��� I31oc1: _�Sy <br />City - �,c_-r�- :�f Phone �� ',� ; -j�GG Subdiyision (P1aC) T <br />— �- <br />Architect/Engineer -=-�Nin ����ryN s-' �, c,l'..•� ,: , <br />% <br />City ��; u� y:� � Phone 355�- 3 i oo Metes &' IIounds (UnplaLLcc1) <br />Contr�ctor � r� /i L= '�� %r �- Sec. Ta�p. Rge. . <br />Address � / 4� �' r�. �n .,, �✓�. <br />City f�� unr ,' Phone �s3_ y33 � � <br />State Li�ense t3umbe�j3-o� S��-�'P - <br />�� <br />Er.pi*ation Date y /- %6 � ��y <br />� ' IIuilding Usc �/�p t�j-� ' <br />•� Describe I•:or?: to Be Done <br />. --") ��/ / <br />COI�v"� PLOP PL61; 0:� R,VB?5E SID:; �r��' "%✓ N o� � R� �r (✓�'7�� d t/ — <br />Nunber of Stories / <br />• ' � Basement �o+ <br />' . ' " ldew Addition Repaxr./Rer,�vdel' <br />_ , . • . Vaivation of Construction $ � J,'>D <br />. . . Signed IIY �'�/ �)��_ <br />. For ��i���- / `''"`/ — <br />� Owner • Phonea5<-yy(� <br />• Do t�ot S•;riL•c IIelow Tl�i� Linc -For Cily Usc Only � _ <br />Datc Reccived `; % �: �' i 1� ' ' ' ' ' ' • � Use Sone ' • <br />If].an Checl: Number t�-/��� �l-' • Firr. 2one <br />Valuation %'�' cr�Ff �^" ' • Occupancy •Group 1 <br />Pernit Fee (' � % • ` � � YP _._-=�= � <br />T c of Coiisi:r.uction t 1 <br />Plan Cl�eck ree � <br />