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IIUILDING PERMIT APPLICAT7:ON <br /> Applicant To Complete `Phis Porm <br /> If more than one building is to Ue constructed, suUmii: a separatc permit <br /> application for each building. A separate, permit taill Uc issued ior each <br /> buildinc . � L� �j/ �,��� /��- <br /> J�i� • ��r-�i't�`� l �'�)Clll'�7.�� �'LJ <br /> Owner �,i����J Building Address <br /> � -� - �l T _j ��/ Lot �� �i Blc.ck OC�O ��-fY0 <br /> Address'Z � _ <br /> City ,� Phone _ Subdivision (Plat) �, `.� � <br /> Architect/Engineer <br /> City �-, Phone Metes & IIounds (Unp.lat.ted) <br /> Contractor,� � �..�° n. o � �'�`= Sec. � -, Twp. v `� Rge. �__ <br /> Addr.ess / � - ��� � <br /> ! � �� <br /> �.'lt� fJ . /=�i�O11C' lj:� <br /> State LS.cense NumUer. �7,7.��i"0'%�������� <br /> Lxpir.ation Date �_�����,___ - <br /> - J <br /> Luildi.ng Use <br /> DescriUe P7ork to Be Done �Go'�-`-�'-'�-� <br /> � �, ,� 1! crf^��.- <br /> . �a '�"�•L 2�i.r n�L ..y�G <br /> NumUer of Stories / � <br /> IIasement. - <br /> iJ�W Additi.on Rep ir/Remode�r— <br /> Valuation of Construction $,� y� i <br /> r <br /> Si9ned By - '--��� _ <br /> I'or ( <br /> Owner Phone _ <br /> Do r�ot t+'rite IIelow 'Phis Line-For City Use On1y <br /> Date F.eceived Use Sone <br /> I�lan Clteck Number. Pire 7one <br /> Valuation _` Occupancy Group <br /> Permit L'ee _ Type oL Construction _ <br /> Plan Cl�eck P'ee OccupanL- Lead <br /> Total I'ee Due Spr.inklers Required <br /> Dai:e Issued <br />