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BUILDING PERMIT APPLICATION <br /> Apiilicant To Complete This Form <br /> If more than one building is' to be constructed, submit a serarnto permit <br /> application for cacti building. A separate permit will be issued for each <br /> building. <br /> is <br /> Owner Building Address �/D <br /> Address - �!� �� �� r, Lot ;;26- ,F/ Block �/ _-_L <br /> City �vt,et Phone 6� Subdivision (Plat) <br /> Architect/Engi er _ xw eAr <br /> city Phone Metes & Rounds Unplatted) <br /> Contractor _ Sec. Twp. Rge. <br /> Address _ <br /> City Phone <br /> State License Number <br /> Expiration Date <br /> Building use <br /> Describe Wor): to Be Done <br /> C01 1= PLOT PLAN ON REVERSE SIBS <br /> Number of Stories <br /> Basement <br /> Nei ddition Repair./Remodel' <br /> Valuation of Construction <br /> Signed By� 7�. <br /> . For <br /> Owner Phone <br /> Do trot Write Below TYJ. . Line -For City Use Only <br /> Date Received Use Sone <br /> 151anCheck Number Fire Zone <br /> Valuation Occupancy -Group <br /> Permit Fee Type of construction <br /> Plan Check Fee Occupant Load <br /> Total Foe Due Sprinklers Required <br /> Date Issued <br />