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<br />~~ <br />r <br />~;al''; :--~~"~~ .~ ~ PERMIT APPLICATIbN FORM <br />Building / Mechanical *Electrical *Plumbing <br />*(See back of form) <br />Project Address: .~S'D ~ IA1 Fa~J~~9'Y~' ~, Lot: d ~-~3~ <br />Subdivision: ~ ~' ~ ~ . __ Block: ~~ ~L5 <br />Owner's Name: ~ R F 0o ~, 1'Ytfl RT ~d (f2 udy G . i~~~ k R~RY~ Phone: ~ ~/ - 77 z3 <br />Address: q ~a ~ ~ L I <br />' Street City Zip <br />Contractor: ~ ~~'k1'1~Q1L Phone: (_1 <br />Address: <br />Street City Zip <br />Engineer: ~ . <br />J j <br />Designer: ~ <br />Building Use: _ r ~t~LILJ Sq.' Footage: ~ Stories: <br />For City Use Only <br />Occupancy Type Flood Zone Class Work Sq. Ft. <br />Construction Type Use Zone ~ Stories Parking Requested <br />Cos~rnercial Buildings Plans Only -Fire Marshal Approval: Date: <br />Checked/Approved for Issuance By: ~ ~ N'~E D ~ • w~~M~~ Date: a2/ - rl6 <br />Special Conditions: ~ D F rys ~.~ Z3 SSE D an/ ~ F.= G u R E /0 - ~ C.Cu r~ (3 R-nrf~ <br />DR~V.zn~~ c,~r-~.rt;g) .~~c~- ~o -~~os • czTy zo~;~~ oat ~~sof <br />Permit No. - Permit Fee ~ ! (attach to actual permit) <br />_,: <br />