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<br />� , � • nvzr,n�:Nc i�rR�,�z�r nrrLz.:n��r.or� . � •':
<br />' n��;,.licanL• To Comp]eLe Thi.s"`IPor.�n .
<br />Ii more than one bui.'.�li.ng is�to be con;�rucied, r,nUmit a separ.aL-e per.mi.L
<br />�1�Plicztion for each buildi»g. A separate pe�.-mi.L �•ri.11 be issued f:o�� each
<br />bui.lding.
<br />O4tner Gc._,, y 1. ��y. ,,.� .,..:. i.- , IIu•ildincl i�ddress ":� rt �,�.,.._
<br />Rddr.ess Q� C�1 c� �,- I\-.� �_ Lot- 1 � 131oc):
<br />City �.)<,v.�._�.•,- Pho�ie ?5' -�jc,,,.,':_ Subd.iv5.si.on (Plat) C.. h"Sc��Ui�-'
<br />Archi�ect/Pngincer _ �.;�.-�-y �� �._ ,�, • �-_,�_._ ,�
<br />City _ Phonc tdcte:, & 13ound� ;Onpl�iitcd)
<br />Ccn�rccL-vr �;_,. �. ( _ Sec. T�,�p. __ Rq�=•
<br />Is3dr_-ss S ra „v..•
<br />City Pliorie
<br />Sta`c Licease l�umber
<br />�r.pirztion bate
<br />COi�?,'� PI,G_ PiGi7 Oi1 RE;�?ZSr' SII)g
<br />IIuil.ding Usc
<br />Describe 19or1: {:o I3e Done
<br />--�
<br />. c..r ar_i.� . _.��.C.4. ��c,,,�-�....
<br />� -
<br />ni�mber of Stories
<br />7sasement-
<br />— / "�"-�
<br />., t�'e�•� ncldition I:epni.n/itic,��dc'1
<br />Valuation of Conctructi.on $��;,�;
<br />Signed BY �� Q ..� _•.Q.�-e.._S>�.
<br />i01 SAm�
<br />�l�'AE�1' � P]1011@ J��:�^i�__�1
<br />•__ T;o 1?01: j•7rite ]3cicn;� 7'his Li.ne -I'or Ci.Ly Usc Only
<br />Date :teceived ','.��,�j �_T�-r . . , ' Use Sonc ,f�� ���,�-,.- c�. l;,1�;,, :�:�.
<br />lTlan C�ecl; tdumber _](., _ Z_C_`,a. � J'irc 7,onc ��'
<br />Valaation ( � UU(�.G<�' ' • Occupancy.Gro�p '
<br />Yerr,;it I'ce � �' •
<br />.`1 U Type of Con �tr.ucL-ion `� ; 1
<br />Plan Clieck I'ee L.� -``' Occupant 7,oad
<br />`l'oLal Fce Due _ uprinl:].crs Rec�uired -----
<br />n�,t:o rs:;n�a
<br />� � ciT� OF'EVERi=.TT
<br />��� �f • • APPR01/GD FOR •BLIILDIN(i P6Rh111
<br />� �i:=�
<br />� .� � � � • �n,te_': ��� �-�., Aya ��w..�:..:. . .., ..._
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