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BUILDING PERMIT APPLICATION <br />Jurisdiction of <br />BUILDING PERMIT NUMBER: B- <br />DATE OF ISSUE ! ! <br />THE CONTRACTOR VERIFICATION FORM MUST ACCOMPANY THIS APPLICATION. <br />CONTRACTOR OR CONTACT NAME: Wr, Von 0 ,Ts,la H•s ?., <br />APPLICANT MUST COMPLETE ALL NUMBERED SPACES PHONE #: cr-7 zf ? r 2 1 7 ) 7 7 <br />Z. r C7 ,., <br />C /,0 <br /> E! <br />. <br />OWNERNAME <br />MauNC aoDRESs <br /> <br /> ITY STATE ZIP PHONE <br />1. LEGAL DESCRIPTION <br /> LOT NUMBER BLOCK NUMBER SIrBDIVISION NAME <br /> lee OR MEETS AND BOUNDS l? W • / sec it <br />?o rti?s <br />/ No, // 1 <br /> S TOWNSHIP RANGE <br />3 JOB ADDRESS: o `-` • <br />. d Z <br />cq <br />4. ARCHITECT OR DESIGNER: - <br />_ C STATE ZI PHONE <br />5. ENGINEER: <br /> <br /> <br /> CITY STATE ZIP I{E <br />6. LENDER: r / t _S. _) <br />oo <br /> m? o 400/ o e. v a <br /> C HONE <br />/. UJ:C VV t1U.LLL11NL7: Vellet n <br />S. CLASS OF WORK. NEW 17ADDITION QALTER.A.TION OREPAIR CIMOVE OREMOVE <br />9. DESCRIBE WORK. <br />0*2 ti n /? <br />NOTICE This permit becomes null and void dwark or construction is not comet within 160 days, or i(coriftuction or work is Suspended or abandoned for a period of 365 days at <br />any time after work is commenced I hereby certify that I have read and examined this application and know the same to be true and correct. AD provisions of lows and ordmances <br />governing this type of work will be complied with whether spedfied herein or not The granting of a permit does not presume to give aulfwrfty to Violate or cancel the provisions of any <br />10. other stategW9ca1IAyr reftling consWclion or the performance of consbudion ,15:;" <br />..-1 - <br />,f f <br />,.i / <br /> <br />DO NOT WRITE BELOW THIS LINE DO NOT WRITE BELOW THIS LINE <br />TOTAL FEE VALUATION OF WORK BUILDING PERMIT FEE <br />'REPAYMENT DATE PREPAYMENT PAID ZONING FEE <br />?OTAL BALANCE DUE TYPE OF CONSTRUCTION OCCUPANCY GROUP DIVISION <br />ONING APPROVAL <br />[?Y ? L SM OF BURRING <br />TOTAL SF No. or MW Occ <br />Stories Load USE <br />ZONE <br /> SIT I FRONT <br />BACKS SIDE * SIDE BACK <br /> SPECIAL APPROVAL T APPROVED <br />REQUIRED <br /> WAER t <br />j ? <br /> <br />i <br />aiwo <br />?K3?•? - ?Ji3/07 <br />T <br /> SEWER f W?:5 t - c'I <br />,E0AL CONDITIOrS S z? a Hn,c4+edl (meter- P&Z SIGNOFF <br /> t,94 <br />gyp,... (Z w 3 E3 DESIGN <br />W <br />. <br /> REVIE ,t4 aej /o7 <br />t?e? // Zr9o OTHER # S? tt.?:.h Ne rn ?..r?.?i <br />APPLICATION PLANS ED BY APPROVED FOR <br />ACCEPTED BY ISSUANCE BY r^ O•I?CYF'iV i "1'C G'1' 1[?{' i O•