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, • DUTLDING PERMIT APPLICA'PION . �3 J- �G. � ,• <br />• Applican� To Comp].el:c 7'his 1'orm -'�� <br />. �/�'�7� <br />If mo:e than one buildi.ng i�'to Ue constructed, submii: a separ.�te per.mi.L- <br />app2icat•ion for. cach buildinq. A sapsrate ��cr.ntiC r�i.l.l be is:ucd for. cach • <br />buildinq. � � � ,� �� <br />, �L' <br />/� /��� '"' ��, � ��-,—� Building Address —% <br />Oamer �. ,. ���- �� y F � c� <br />Address.� `S ;�/ S�� or� Lot J31oc1: <br />City �,,..�,._f ..� ' Phonc � S� S -�YS�/ SuUdiyision (Plat-) • _ <br />� <br />Archi�cct/�ngineer ��-�.-���" <br />City 1'hone Metes & IIom�ds (Unplattecl) <br />Cor�tr�ct•or ✓�.�,,_�" _ Sec. T�vp. _ Rge. <br />Address <br />City _ Phone • <br />State License humber <br />Es:piration Date - <br />C0]-F��_„=' PI,OT PLAil 0:� R�V�RSE SIDL <br />a <br />Do t?ot �•;r <br />Date Reccived <br />ilan Caenl: Number <br />Vatu�tion <br />Pem�it Fee __ <br />Plan Check Fee <br />Total 1'ec lluc <br />Datc Issued <br />Building Usc ;�`i�./�-�'� � <br />Describe S?or}: t-o Be Done <br />,� : � � <br />�r, t�<-•�� �r-t.v'�- ��-��.� � _ <br />Number of Stories 'Y <br />Basement •— <br />' Idew Addition Repair./Rer,�od�' <br />Valuation of ConsirucLion $ <br />-�l/�%��O � <br />Sign d IIy �� �' % ��-- � � � / <br />. , ,. <br />� �. —_ <br />. For i, / � y <br />Owner � Phone�S�S-4j�T <br />IIelo�•r Thi.s Li.ne. -I'or City Use Only <br />" " " • � � Use Sone ' <br />' • Fir.c: 2one _ <br />Occtipancy •Group �_ . <br />Typc oL Co�z:�i:ruction _ 1! 1 <br />�ccu��ant Load <br />Spr'nlcicrs Requircd <br />. , • , . i, fi <br />• . . .��.1 <br />