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� . • DUI7�DING PT•.R14T'P APl'LTCATIOP] . >�/�' �l �+• <br />• Applicant 'Po Comp].eLe Thi.s Por.m '`//3 �/,�� �� • <br />If moze than one bui.ldi.ng i,�to be conctructcd, subinii a separ.ate pe;:mi.t <br />applic•�L•ion for cach Uuilding. A septiraL-e per.mi.L �,�i.11 hc issucd fo�' cach <br />buildir�g. <br />OYmer j��r�,/e-. Ln.%� �� IIu•ildin, nddress <br />� <br />Address QZ31�9— %''{' . Lot /'{-�_. ]31oc}: <br />City _�r/eh�%� Phone Subdivisi.on (P1aL-) _,,-„'^,�/ �,4i'✓� <br />_ � <br />Architect/L'ngincer /�.iri T i=Jo�'-'l <br />City Phone Metes & 13ound� (Unple,tted) <br />contractor o�NER �c !�F_tUr. l.L; sec. �r�,�>>. r���,. <br />Rdar_ss �, �jnk /�0 --- — <br />CitY � df � �"�" Phor.c�< _ io�� . <br />Statc Licease Number��� -0�- �07/ _ �. <br />Er.pi�ation Date JG-(7�-i�n <br />COi3'T� PLOI PLA2; Oid P,�Ss?tSE SID� <br />IIuilding Use ' <br />Descrihe F7or1: to Be Done <br />Number oi Stories <br />Basement <br />• . �' Nec�� Addition RepaS_r./I:emodel' <br />Valuation of Con�truction $� <br />, , <br />Signed' I3y. �%r �..1 - <br />For /, <br />Owner � Phone <br />�- ' Do I'ot i•7rite 3clo�:� This Li.ne -For. City Use On]-y <br />Date Received g�/[P "' ' ' Use Sone <br />IS1auChecl; Number ?CD—!�3' � rirc� 2one � <br />Jaluation /-��-BU ' • Occupancy •Group <br />Pernit I'ee 84- B� Type of Co�t�truci:ion - _ <br />0 <br />Plan Check Fee �2 •� Occupant Load _ <br />Total T'ee Due ^ Sprinlclers Requirect _ <br />Date Issued � <br />CI�iY G`'�C':ii=H'_i � <br />� . . , AI'PR01'•�i) FO;Z [�UIt.Dll�i� P�i�fvill <br />. • • �• . ' . - ' • `�te_-;='-�-_- '-- �3y _. '� .-------- <br />