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BUILDING PERMIT APPLICATION ' <br />Applicant To Complete This Form <br />If more than one building into be constructed, submit a separate permit <br />application for each building. A separate Iiermit will be issued for. each <br />buildin-`� 1 t. - <br />Owner I )AryAcz'� <«nn�InmE Building Address <br />Address E\It--' C.,k?i LX- I'L ) 0 Lot 1310e1: IMITEr <br />city Evrer-rt Phone OC,1 Subdi�lvision/ (Plat)zz <br />Architect/En gineoil- v,.. v=:: �N y &C'^ <br />CityPhone �; t-_fin Metes & Bounds (Unplattcd) <br />Contractor7&n�, ' �N„crnw, ��n - C ive . Sec. Twp. Rge. <br />Address Yy3;' E\1Gl'_r a[Eb:L)HYL — - <br />City1=„rape-r PhoneQSQ -inn, <br />State License Number 22'301- I kt (r <br />Expiration Date '5714,11/? i <br />Building Uses;• • ►- �*��� <br />Describe Work to Be Done <br />Col, PLOT PLA17 ON REVERSE SIDE <br />Number of Stories CAit= <br />Basement �� n <br />Netr� Addition Repair/Remodel: <br />Valuatio of Construction $ <br />Signed R <br />For - <br />Owner Phone�Srl-laol <br />Do Not Write Below This Line -For City Use Only <br />Date Received " " " Use Sone <br />Islan Check Number Fire: Zone <br />Valuation _ Occupancy -Group <br />Permit Fee Type ofConstruction <br />Plan Check Fee Oer•.upant Load <br />Sprinklers Required <br />Total Fee Due <br />Date Issued <br />