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,- j:t� <br />� : <br />, � �,Y' � <br />IIUILDING PERD',IT APPLICATION , <br />�PP�icant 'Po Complete This i�orm ���������� <br />If more chan one building is to be con5t:�+icted, suUmit a separate pennit <br />application for. each Uuildi.ng. n scparat� permit taill be .i.:;::ued for cach <br />building. <br />� <br />Oc��ner �� .�r J� 13uilding r;ddress ���c'j �Ilt—;��. <br />Address ���� �(�,��' ��,. _ Lot IIlocic _ <br />Cit,y 4�`��$��: Plione �L�-��J SuUdivision (Plat) <br />nrchitect7:l\ingineer <br />City --� \�— Phone Metes & Bounds (Unplatted) _ <br />Contractor �;� �`+2�� q-� �QrQ3J,� �(�, Sec. Tcv-�. _ Rge. <br />nddress ���, �1.ieSs3���� �_, <br />City �V°" itti� Ph� n�' � 1' l � <br />State Lice:�se NumUer ��.?�-�/- ,�/ i?.� <br />lix�i�-aiion Date � - I- '��- <br />I3uilding Use <br />Describe i9or}: to Be Done <br />�9� � M ,�.�L— <br />� j� �.4 e <br />� a �2 . , <br />Ni�mber of taries <br />I3a semen� <br />Iveca Addition Repair/Remodel <br />Valu��tion of Co�lstruction $�,��� <br />Siqned—B <br />ror `��t3� .— ���.il'�`�(1 / <br />Ocaner Phone .� �� '���1 � C- � <br />� � — <br />Do Not P7rite I3elo;a This Li.nc-I'or City Use On <br />Datc l:eceived �� % � <br />trlan Check I�umber -- <br />�h <br />Val.uation �$!�.� <br />Per.mit Pee y �� <br />Plan Checl: Pee <br />Toi:�l Pee Due �/, OC,' <br />Datc 7ssucd _ � <br />---� � --- <br />i <br />Use Sone <br />I'i..re 7one <br />Occupancy Group _ <br />Typc oL Construction <br />Occupant Lozd <br />SPrii�lcicrs Rcquised <br />