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. d <br /> �� n � <br /> • �a�i�i er r,�:;-r.;:�rT � rLrcr�� No. <br /> ' Di;PAt?,1,�,1,;!,:'i` 01' CO:d?1Ct7J7'I'Y DCV];I.OYt4ENT <br /> �UI1,UI[]G PJ:I:iIIT i,l`i'].:ICi�TIO;J VALU7ITION s�4�� $��Q <br /> F1i1L�lIT F'L•'I; � �Z ". <br /> UI�TG SCPTG��� [iEC fz, Iq74 '�0..� G�Ck �°" � <br /> ADDRESS OP CONSTRUCPION WORK 819 ��P�NF OFiuc- , <br /> i <br /> LI:GAL DESCRIYTION: LOT � I ALOCK PLI�T EUcreceecu Qq�E <br /> llNYLATTEU DLSCRIPTIUi� $C= � op THf S�u y oF SpuTicv f/+ T wN.wrp .�'] � <br /> � �!'uTil I�ANGt � fAST 1,�N� D(�eRi&'q '�"�0 FZC�CCOcD �N 1�6��.Mt l� �f ���tS <br /> / CN PQ6C' � Cc SNGNL�1�f'P `CuvTY . WrtSI•IIrW.��tN <br /> Sl1ILDING DESCRIPTIOi�I: NEW _� AUDITION ORMREPAIR <br /> N' OF UNITS � OCCL'Pi+NCY OR USE /�svoc�.ca STORIES / 't' f.sgncr,�; <br /> IS THIS A CEIANGE OP IIUILDING OCCUPANCY: YES NO X <br /> CONTRACTOR RoeEar �. S�µAu�r� , owr��x ROB�'QT L. S�FqutC <br /> MAILING bU1ILING <br /> ADDRESS 257.4 73 � 5r. ADDRESS 15�4 73� 1t <br /> EvcA�rr Wn 9Yzo3 E�.-�c� IN'a, qYz43_ <br /> PHONE NU1tBER 353- 91oF PHONE NUF1BEIt ,353 - 9s�Y <br /> CONTAACTOR'S LICENSE NUDIBER <br /> SIGNATiJRE ��-�� � ��� <br /> � NOTE: TH� AYPLZCANT SHALL FILL IN ALL ABOVE IILIINKS COPIPLETELY INCLUDIVG <br /> TNE PLOT YLi,:. Sf:EiCl1 0�1 F.:AR OF THIS SFiEST. TIIE APPLICAPIT IS RESPONSIBLE <br /> 1'OR ALL II:PORi•LyTI0:1 C:HICIi IS FURNISHF.D ON THE APPLICATION. ANY CHANGES <br /> IN THE IhFORi•SATI0:7, PLOT PL1�N OR BUILUICIG PLANS SFIALL BE SUD T ED TO TIiE <br /> INSPECTIOV DIVIS20:1 I'OR APPROVAL BEFORE PROCEGJING WITH TI1 � O STRUCTION <br /> WORK. <br /> APPRO�AL: <br /> 1. PLANNING DATE <br /> 2. ENGINEERING _ <br /> TRHT'FIC D7VI:ilON <br /> {9AT};R SERVICE <br /> Sk'sWER SERVICG , <br /> PUllLIC SERVIC� SECTION <br /> ?. INSPECTION EPAI2TP1 C7T � <br /> -T,�•-�o `% J y/- 7" --- <br /> , � `'�y -- <br /> --��----- . — <br /> 4. I'IRE t4ARS11AL ' <br /> NOTG: AI,]. CO\:;TRL'C'i'7A:J P:OI:i: SIIALL C0.'1PLY NITIi APPLICA$LE CODFiS, idOTI:S <br /> ON DI'��•II:7CS, A;ID Ii.SYI:CPIO:.� <br />