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' , • • DUILDING PP•.RMIT AFPLTCAT201� • / �S �� �. ` <br />• ? <br />� _ . Applicant To Comp].ete 'Phzs. Por.m ����//�/,/ ' <br />Tf moze than one bui.ldi.ng i,'to be con�tructed, suUmit a separ.ite permi.t - <br />applicat:ian for cach building. A separate pe�:miC will be issneci for e��ch <br />buildir�g. , <br />O��ner �! rnr� . �)i . -,. ��� � � . ( , � IIuilding Address =1;- � ; __ _� _, <br />)' <br />Addr.ess ! �.-� -( "C��'' � �- `-- I � ` Lot � � )31oc}: <br />City �Ilr'�►"c'_-��( Phonc �'�j_C_(�-':;' �. Subdiyision (Plat) �,_;�����,n � <br />Architect-/L'ng:incer . <br />City Phone tdetes & 13owids (Onplattecl) <br />Contraccor ��.,,�-� �. Sec. T�.p. ]�ga. <br />FiC1CiTL"�c5 � . <br />City Phone • , <br />Statc License Number . <br />Er.piration Uate <br />C01•TT_.,s"i:: PlOT Plli17 ON REL'E?7SE SI� <br />Building Use 'r ��: ic-(F' r� n� . <br />� Describe P7or1: to IIe Done <br />Fc" '� (i7/(�- I Y'C'ii I� ..i.�.�.��1 <br />.. � t �,i� t' i <br />Number of Stories <br />Basement <br />' Ne�a Addition RepaS,r./Remodel� <br />�'aluation of Const�uction $'� �,(Y' <br />Signed IIy �, � �, ;- ,Jr l ,,.��� <br />� \ <br />For <br />Owner • Phone <br />• ' Do I'ot T•7rite Belo�;� This Line -For City Use Only <br />Date Feceived ����� ' Use Sone • <br />IS].an Checl: Number ' • Fire 2one <br />Valuation _ ' • Occupancy•Group <br />Perniit Pee • Type of CoilstrucL•ion ' <br />Plan Check Fee � Occupant Load <br />Total Fee Due _ Sprinlclers Required <br />Datc Is�ued • � <br />