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BUILDING P)iRMIT APPLICATION <br />Applicant To Complete 7lii� form <br />If more than one bui.]ding is'to be constructed, submit a scparnto permit <br />application for each building. A separate Permit will be issued for each <br />building. <br />Addrewner <br />ss JSyT,r� y�N n /N Building Address <br />Address � �✓ <br />y—_j747 <J� A Lot _ /O _ Block <br />City Ao_! Phone Z (�J'6 <br />-�1�_ J Subdivision (Plat) !°Ts 4Eio <br />Architect/>;ngineer �,_� <br />City Phone Metes &'Bounds (UnPlatted) <br />Contractor <br />Sec. <br />Address/��TwRge <br />City r;_T Phone —�-- <br />State License Number —��— <br />Expiration Date / <br />Building Use <br />Describe Wor)-, to Be Done�gr_ ,, 0 <br />COIP*W� PLOT PLAIT ON REVERSE SIDI; <br />r� 1=A�/.57�//1(C-' ncyaiNiiY�• i <br />iir.y-r <br />Number of Stories <br />Basement <br />New Addition Repair./Remodel' <br />Valuation of Construction $� <br />signed By <br />Owner :u(oPhoneSll�' <br />Do Not write Below <br />This Lino -For Cit Use only <br />_Date Received •••••. <br />"� <br />Plan Check Number <br />Use Sono <br />Firr. Zone <br />Valuation <br />Occupancy -Croup <br />Permit Fee <br />Plan Check Fee <br />TYPO of Construction <br />Total Fee Due _ <br />Occupant Load <br />Date Issued <br />Sprinklers Required <br />---- <br />