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BUILDING PERMIT APPLICATION 3 3 - ���•� <br />S <br />Applicant- To Complete This Form <br />If more than one building is•to be constructed, submit a separate permit <br />application for each building. A separate pca:mit will be issued for each <br />building. <br />Ovrner l� V 6,. d / / n n <br />Address /�. ;L • �',Z -� <br />City F,/c f? 4H Phone <br />Arcbitect/Engineer <br />City —Phone <br />Contractor i — <br />R rc ss <br />City <br />Statc License Number <br />Expiration Date <br />P.,ono <br />CONPL=E PLOT PLAN ON RE11D?GE SIDE <br />•'/r1J. <br />Date Received <br />Vlan Check Number <br />Valuation <br />Permit Fee <br />Plan Check Fee <br />Total Fee Due <br />Date Issued <br />Building Address ?,, 2? <br />Lot _ Bloc): <br />Subdivision (Plat) <br />Metes &'Bounds (Unplatt-ed) <br />Sec. Twp. Rge. <br />�p-c. •.�> .i r rt ,tit l iL% • ; i' /-'�i' i�S <br />Building Use <br />Describe 11ork <br />to Be Done <br />Number of Stories <br />Basement <br />New Addition Repair./Remodel' <br />Valuation of Construction $ 140 <br />f� eU <br />` <br />Signed By .=rL •�' . 56_ _e <br />For <br />Owner ( Phone 2/6. L..l <br />Write Below This Li.nc -For. Ci <br />Use Sone <br />Firc: Zone <br />Occupancy -Group <br />Type of Construction <br />Occupant Load <br />Sprinklers Required <br />:v Use Onl <br />11 <br />