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• DUILDING PTiRMIT APPLICATION • �'� ��'`�� � � <br />_ . , ;�.% % <br />� • h�i�licanL• To Compl.etc T.hi:, Porm� ' S�;o�j� <br />If moze than one building is�to be construckcd, submit a separ.ate per.mi.t � <br />applicaL•ion for. cacli buildi.ng. A sep�rate permit wi.l.l bc is=ucd for. cach • <br />buildir�g. <br />� �D/D ��RDSTIZE�r <br />Ovrner %V�F.�'��Y�. �il��/'/i%'•;. �/�F}�IC-�l�I I Building Address <br />�aaz_�S Sc rc •3:3 �° S�R��� . Lo�: #..L.1�— n�o�� -� <br />City kVER�`[T Phone �53-39bS Subcliyision (P1aL•) • <br />SHoRE" C ES ftDD ITIp t`! 'ro <br />Archi:ect/� C^�O�f_ L�ANCL-V1�RIc1-1 �, r��-v�-�-���L��H�' <br />City RLI 7CN 1�hone 435�5�(07 Me{:es &' IIounds (Unpl�itLecl) <br />Contraci:or gY OWN�tZ Sec. Twp. _]tge. • <br />Address <br />City Phone � <br />State License 13umber <br />Er.piration Date <br />CD]-��_Y' PLOT PLL?� Oi�� REVERSE. SID� <br />Building Use �'E�y � p�Ef�[ e� ' <br />� *Jescribe T"or}: to Be �ore <br />. � <br />,�12D ITI ON OF�NT12`� �E <br />1`�n cA� rAIz.AG� <br />Number of Stories �NE. <br />Basement Iv O <br />" I1eta � Additio�i Repai.r./Rer.�odel� <br />Valuation of ConsL-�ucLion $ <br />Signed IIy , � � _ <br />. For <br />Owner � Plio�ie <br />Do Kot i•'rite 13elow This Line -F'or Cicy Use Onl <br />Date Ceceivcd 3 %�q�Z� ' ' ' ' ' ' • � <br />T'- <br />Islan C;�ecl: Number ZLo—!�! 9 • <br />Valuation CPl90- � ' ' <br />Perr�it Fee �p <br />�' <br />Plan Check Fee 'L�' �� � <br />Total 1'ec lluc �I�� �' <br />Datc Tssued __ <br />. " <br />Use Sone _ <br />Firc 2one <br />Occupanc.y•Group _ <br />Typc of Co�isi:�:uction <br />Occupant Load <br />Sprinlcler,s Required <br />