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DUILDTimi m: *fl1;iAPPLICATIOil <br />✓ ApplicnnL• To complete <br />This Form //�7 h7 <br />If more than one building is'to be constructed, <br />A sepuraL•c <br />submit a separ.ntc permit <br />pw-miL will be issued for catch <br />application for each building. <br />building. <br />�• �����- <br />Building Address <br />Owner efj <br />Lot T Block - <br />Address <br />City ti�� E" Phone: �S ''�� <br />Sub,d`ivision (Plat)a _ <br />C?r�� <br />�Arud <br />Architect•/Engineer <br />Metes to nounas (Unplatted) l• <br />City Phone <br />`�rrc 1,vU <br />Contractor <br />sec. zya,1,, Rge. <br />Addr�•ss 6��� - z Iv skl, <br />City Yet ✓ Phono 77(e_ 1 ' <br />State License Number <br />?rrpiration Date <br />Building Us: FS <br />Describe Work to Be Done <br />Coa.77.-- PLO? PI4611 oil REVEM ; SIDS <br />- <br />"-""" <br />Number of Stories <br />Basement <br />-New Addition Repair/Rcmode l. <br />SSd� <br />Valuation of $ <br />/construction <br />Signed By <br />For <br />Owner hone <br />Do VoL )bite 11010w Thin <br />Line For. Ci t.y use only <br />Date received <br />Use Sone <br />Lslan Chcc1: Number <br />Firs 9,one <br />Occupancy -Group <br />Valuation <br />alua <br />•• <br />of constrction <br />Type u <br />t Fee <br />Occupant Load <br />Plan Check Fee <br />Sprint;.lers Required <br />Total Fcc Dun <br />Date Issued <br />