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33 z -. 7� <br />� a IIUILDING Pl�ih�liT-71PPLSCATION . �`3`3/� j� <br />Appli.canL• To Complete This. 1 orm �%�l <br />If mor.e than one bui7.ding is�to be consi�ruci�ed, submit a separate permit <br />application for each buil.ding. A separa.`.e permit will he issued for each <br />buildingi� �l �, �,/" 9�5� .�3. a,,.� y�.^� <br />B i]ding Address%� <br />Ovrner �,�., <br />Address �E � 0 5 <br />Cit��-y��-�.c� <br />Phone ,� 6 b' 3 0!� E' <br />Architect/EnqiPrc'�Y' o <br />City ___ Phone _ <br />Contractor �A�ri-e <br />Address <br />Cy�y Phone <br />State Li.cense Number __,_ <br />Expiration Date _ <br />F <br />Do T'ot ��rite ]3elo�a This <br />llate 3:ecei.ved Z/4�7 � -- � <br />1�lanGiecic Number !�'��� <br />Valuation Lo � �`�' <br />e �� <br />�v <br />Permit P'ee 'LD7' <br />' 'C <br />Plan Check P'ee /O�-�' <br />Total 1'ee Due � [ d .4�'� <br />DaLe Issued <br />� <br />� <br />u <br />Loi: ____ Block <br />Subclivision (Plat) <br />tdetes k Bo�nds (Unplatted) <br />Sec. Twp. Rge. <br />�� /¢- �� � G v7 � � r� � <br />S 73 3�� ��T /O <br />� LG 2 SHO/z E- /JC l`' t S <br />IIuilding Use • <br />Describe PlorY, to ]3e Done <br />Number of Si:ories � _ <br />Basement � -- <br />Ne�a Addition Repair./Remode.l <br />/ pv <br />Valuation of Construction $(� G '� <br />Signed IIy <br />(� ` <br />i <br />P•or — - <br />��,�n�r Phone <br />ine-ror City Use Onl}� ___ <br />Use Sane �' S ���—u�---«—�"-�d—�—=-- <br />I'ire 7,one -'� � <br />Occupancy�Group <br />Type of ConstrL:cL-ion _. <br />Occupant- Load __ — <br />Sprinl:lcr , r.��Uz.r�a _�_. <br />