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• . t . <br /> , • IIUILDING PIiRMIT API�LICATIOI�i � /l���j�' <br /> � <br /> • • Applicant 'Po C�m��l.eLc `Ph9.s 1 orm ' � , <br /> .� y� 3���,�� <br /> If more than one bui..ldS.ng i,' to be con�truct-cd, suUmit a se�>ar.ai:e per.mit " <br /> appli.calion L•or each Uuilding. A separaL•e per.miL wi.11 be issur�d fer. e;ich <br /> bui.lding• • �,`�..f' �: t� f;,'✓1 . <br /> Owncr �v�n S• �� A � 2 p Building nddzcss ,�- -�/9 S-�. Lvu�i� <br /> Address �0 5 - 1 3 �/ /�; _ 5_ (.J . . Lot �J .1 i o I31oc1: 6 . <br /> City L �-�iz-e�4 Phone '�y3-G7i� Subdiyision (P1aL•) `, c,,�� �i <br /> Archi:ect/�ngineer � r ;�.��s�5,� — <br /> City �vtx��4 Phone 3ss-3aoo Met�s & Boundc (Unplatted) <br /> Contractor �� .� Z 2 A �'U n s'�• Sec. Twp. � Rge. <br /> Address �OS-/3 ci /�L S 4� <br /> City L d-cx .¢�.¢ Phone '� �/3�G �/� • <br /> State Lice7se Number�j �-Cl-2 -�e '� yF,�F _ _ �� <br /> �r.piration Date ! f � 7� <br /> • Building Use '�h � <br /> • � Describe I•1or1: to Be Done <br /> COIT?..T'�: PLOT PLAt: Oi�� RF.VEI?SE SIDE �4!° `—�'�--'T u w n �.s c Z j aT/� ;. <br /> Tumber of Stories .2 <br /> . Basement r1oY1 �a- <br /> ' ' ' ' . Net• Addition Repai_r./Rer„odel' <br /> _ . . � .' �.. Valuation of Construction $3oyo,-� <br /> • . . . , Signed IIy a ^ _ ! <br /> - ' <br /> . • . . For � <br /> � Owner Phone �/� 6�/(0 <br /> . .. • ' . . � . . � <br /> . . . • : . , <br /> • Do Kot �•;rite �elow This Linc -For City Use Only � <br /> Date Received � ��� . ' ' ' ' • �� Use Sone <br /> IS1anC �ck Number `7Lo--[�ZY • Firr. 2one <br /> Valuation �L'��(?�- � � ' • Occupancy -Group <br /> Permit I'ee /Z7• `7 � . Typc oi- Construction " <br /> Plan Check Pce � (e 3�`'� Occupant Load h_ <br /> a . s� � "�.�'�4�/•u� n e <br /> Total ree Due / � � S rinlcicrs Re uired <br /> • Datc Issucd - , . <br /> � . , . . . CITY 0,` E\'I�RFTT <br /> • , � . ' . APPROVED FOR E3UILDIfVG 1?ERfWIC <br /> ' � , ' Date-�/-��—�Y �^<"" <br /> � <br />