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6 <br />� <br />• • �. <br />, . ' DOILDING PERI4IT 71i'PT,ICA'PION • L�/ � �( ' . <br />' � An�ilicant To Comp].etc 7`his Form � 3�` �_,�; /,� <br />If more than w�c building is'to be constructcd, submit a separ.nL•c per.mi.t- <br />�PP1icaL•ion for. eacl� building. A sepsrate perutit• �•�i.17. be is:ued for. r_ach • <br />Uuilding. <br />Owner �-T-; ,- _ ,-� . Building nddress � � :,, <br />Address � . _ ^�t , � LoL• ' � '� — <br />� . I31oc1: ^� a - D- ��, <br />City Phonc . " �-, �! Subdi��ision (PlaL•) �.. . �:•,,.•. <br />,: �, ` -- - :.� � � -. . � _ �, I; ,, , <br />Architcct/�ngineer ' � <br />City Phone Metes & Bounds (Unplatteci) <br />Contr�ci-or �,-, �{ Sec. Tcap. Rge, � <br />Addrss <br />City Phone <br />State License l�umber <br />Er.piration Date <br />COl-� `_' PiOT PLl'�N 0:� REVERSE SID:: <br />� <br />IIuilding Use /„r_,,_.: ,,- <br />Describe FTor}: to L'e Done <br />r� <br />humber oi Stories <br />� Basement /�/c <br />� .-- , <br />' " 2��..' Additiwi P.epair./Remo;lel <br />Valuation of Con>t�uction $?,� �-� <br />ti <br />. • . Signed IIy .,. <br />. Far ! „1... c_1 <br />Owner Phone �.C'i - / <br />• Da Not T•iritc IIelo�•r Tl�is Linc -I•'or City Use Ori].y <br />Date Reccived �; � i ! � , ' ' ' ' ' . - � Use Sone • <br />Islan Chec): Number ' • Firc Zone <br />Valu�tion <br />Pemit Fee _ <br />Plan Cl�eck L'ee <br />Total 1'cc lluc <br />Datc IJJLLC� <br />!/ :. C;;..' <br />Occupancy•Group 1 <br />Typc of Consi:ruction '�; �. <br />Occupant Load <br />Spri�ilcicrs Required <br />, CITY C:i= E'e'EC"TT <br />APPROVGD F0�? ru,�oi��G PERfvtil <br />Date---•- _-_ By__..''-=: __.... <br />e <br />