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• I3UILDING PERMIT APPLICA'rION %�•� �i;� �f,C��= %6 � ' <br />' • T;,�ilicant To Compl.etr_ 71his 1'orm� -'%, i�J • 3� � 3�%�J� <br />If moz� than -onc buildi.ng is� to Ue consi:xuci:cci, submit a separ.al:c per.mi.L- <br />� appli�aL•ion for each building. A scpsrate pei:mii: �•ii.11 he i�_ ucd for. eacli ' <br />builc:ing. � <br />Ov�ner .� ti - � ��. �' u.«°�'� l <".� t''''�c, Building Addre�s � j -_. � �' i � .; � �; , <br />�.��� , Lot :Z G I31ocl: _ <br />naar��s ;� 9 > > >� - �'-� . <br />City G�i-��� '' �9"�3 °' `� . Subdiyision (Plai:) <br />Phone ,� <br />�%��,.u-r� ��/'�'•-,"-�J.- . <br />Arerii�cct/Engineer <br />Phane Metes & Bound� (Unplzit-t•ecl) <br />�ity Sec. 3 G Tc,�p. �% _ Rge. �� ' <br />Contr�ctor <br />A�ldr�ss (�/`�� .L� w- �Ls'-c�-�'• <br />City Phone _ ' <br />State License Number z s�_� G�� <br />Er.piration Date � / S �� � <br />COI�T�-= PI,OT PLAT1 Ot3 REVGRSE. �iT�L <br />Building Usc ''/�� <br />Describe �•7or}: to IIe Done �_ <br />.�' <br />Ilumber c_` Stories ��� /�-t-a�'` <br />Basement �"�_----- <br />• � .j�� Addition Repai,r./Rer.,iodel� <br />�� <br />Valuation of Construction $ <br />Siqned IIy � � _ .>._ �>_ ...��...�h��-�^--c <br />r � r. <br />For � , <br />Owner • Phoii ,� SG -��" G <br />C•;ri{:c IIe1o�a T1�is Lin� -P'or City Use <br />Date Reoeived �% �Z ��l ' <br />ilan Chec1: Numbe�� =/73 ' . <br />. �� u . , <br />Valuation � l �i � - <br />t�l �, �,c� <br />Perr,�it Fee <br />cr�� <br />Plan Cl�eck I'ee � 7`�' � <br />Total Pec lluc <br />Datc Issued � <br />Use Sone . <br />Firr. 2one _____�.- <br />Occupancy-Group � . <br />--� -�–'-- . <br />Typc of Con �i:ruci:ion <br />Occupant Load <br />Sprinlcicrs Required �---- <br />� CITY OF '�VER.�TT <br />APPROVED FOR. 6UILDING• PCRMIT <br />_ i- � '�� <br />bate ` i t / �•,.: p�, <br />