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BUILDING rrnim APPLICATION <br />Applicant To Compl etc This form 3/jf17G <br />If more than one yu9.1di.ng into be constructed, submit a separate permit <br />application for each building. A separate permit will be issued for each <br />bui.l6ing. <br />�^ Owner Building Address 9 0- V y il, Jr <br />Address .g 17 fh S r• _ Lot Block <br />City Phone 3S.3-6ii Subdivis In (Plat) <br />Architect/rngincer Alow <br />City Phone Metes & Bounds (Unplatted) <br />Contractor Sec.__Twp. 'ze) Rgo. 0 t <br />Addr_ss <br />City Phone '3 — (_j <br />.Statc License Number <br />Expiration Date _ <br />Building Use <br />Describe P1or.): to Be Done L C <br />COT•= PLOT PLAN Old REVERSE SID Pig 2-1 0 ed <br />Number of Stories <br />Basement. _A/o A/.E <br />New Addition Repair./Itcmodel• <br />Valuation of Construction $�dls-o <br />Signed By ,?ed <br />y For a w xt le. 0 <br />Owner. Phone <br />Do Not Write Below This Line -For City Use. Only <br />Date Received 3 Z 4 <br />Ilan Chech Number <br />Valuation 4 sm <br />Permit Foe <br />Plan Check Fee <br />Total Pee Duo�� C� <br />Date Issued Z 4 h <br />Use Sone <br />Fire_ zone <br />occupancy -Group <br />Type of Conat.ruction <br />occupant Load <br />Sprinklers Required <br />n <br />