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3�0 <br />BUILDING PERMIT APPLICATION <br />Applicant To Complete This Form <br />If more than one building is to be constructed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />building. <br />Owner "_)[')l-N N. ?UO�: <br />Address 0 4 ( a -I 3RD. <br />City E V£ ✓ £ IT Phone <br />Architect/Engineer <br />City Phone <br />Contractor <br />Address <br />City Phone <br />State License Number <br />Expiration Date <br />Building Address 24 12- 1a'gp- a, <br />Lot LC Block <br />Subdivision (Plat) <br />Metes & Bounds (Unplatted) <br />Sec. Twp. Rge. <br />_1 LLt1031 VZ oV- LOT ei) <br />u-'Q" -Tr;_y 1-'JSC E I.S atY NL)or <br />Vl avbE IrJ 00L. • LI 0� PLrJ <br />, � rLCCTDS <br />1tj CCVI-7Y OF SNG��paiS��, <br />Building Use <br />Describe Work to Be Done <br />_ Co0ut-l'T 10Q OF <br />_ elriynOrT 'to 6Ah1rnGL= <br />Number of Stories 0 o <br />Basement Q Ct--1_R__ <br />New Additi epair./Remodel <br />Valuation of Construction $ <br />'- C-C, - U <br />Signed By _ C 13el <br />For Tr1 l h • P,elE444 <br />Owner Phone 3 2D 5 <br />Do Not Write Below This, Line -For City Use Only <br />� Date Received Use Sone <br />Plan Check Number Fire Zone <br />Valuation Occupancy Group <br />Permit Fee Type of Construction <br />Plan Check Fee Occupant Load <br />Total Fee Due Sprinklers Required <br />Date Issued <br />A <br />