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�'`:: . , . _ . <br /> � a ��_ / �� ` _ � <br /> C7TS' OF I1�::7RGTT Pli1th1ZT N0. � '�?� '�� <br /> A:iP/�P,R':di?h7` OP C0:1[•;O:ii'fY DI:V]:LOPI4ENT ' . <br /> L�AUILDI:�G PI':IvdTT i�l'i'L:iCi.TiO:� V�1LUi�TIO:: OD � <br /> YL'I'.�VZT b'LI: �� <br /> llATE SCPTE�� �.cC �z. Iq74 /�a <br /> ADDRESS OP CONSTRUCTIOC] �40F.i< '�19 ii�.Pv�: OP.�uc <br /> LEGAL DESCRIYTZU:1: LOT '' I RLCCK PLAT l-_�c�x•�ce�: flq�e <br /> • UNYLATTEU DI;SCRIPTION �� 'f �r• 7�+c S�'� y cF SCLi1Gti ,I , �c(U'�+�irG 2� <br /> % ^/curFl l�An�E � tA:; L{;',� �c:e�r&'�) �^'n j��ircac �.v 'v�6�umc 73 �F �.•�LS <br /> i, oN Pwee 70 nc $:ic.�fc^ �s �: �`„c�ri U✓n�r��:�erw� <br /> RGIdODEL <br /> HUILDING DL•'SCRIPTIGd: NES4 _� ALDITION p� KEp�IR <br /> 11' OF UNImg / OCCUP�:\C] OI2 USfi 1''tsrac�.:e STORIES / '1' tSe�+F•T <br /> IS THIS A CfIANGE OP DULTDI\G OCCUPANCY: YES NO X <br /> CONTRACTOR �oAE�:T� �-. Sc«�>���r O��INER I�CB��'� �-• �'F��i«cC <br /> t+lAILItiG !•II�ILING <br /> ADDRESS z�,y 73 r9 5r. ADURLSS 2Si.�( 73� $t <br /> � �UE/�ETT �l�A �JY.2C,� EbY'IcC� 6NQ � �/j'<'.� <br /> PHONE NUhIBER 353- Y�'�`N PHONE NU:dBEB �S3 - `7<CY <br /> CONTRACTOR'S LICENS� I�U:•IIIER <br /> i `�' <br /> SIGNATURE 1..,/t.-�..�.-�' �. —o�k�� C'' <br /> � NOTE: TIl� APPLICAi��' :'hALL c^ILL It1 ALL ABOVE IIL71P.I�5 C0:•fPL1:TELY Ii:CLUDI\G <br /> THE PLOT PL:".7 Si:L'^_CII i,.`] .T:�:+R OF THI.ri 52iEST. TIIL: rIPPLICAP:T IS R�SPONSIBLE <br /> rOR ALL It:FORI•LT.iIO:: S•73IC?I IS FUF.:dISIIFD Oi4 THE APPLICATIOi4 . ANY CHeItiGES <br /> IN THE II�FOI2i�iATIO't:, PLOP PLi'�ti OR BUILUI:dG PLAtvS SHALL 3P SCIIM T'i'�D ^10 THF. <br /> INSPECTION DIVISIO:: L'OP, A??i�OS'AL B::FG:tF. PROCELDING WITH TIIE NS'PRUCTIUN <br /> WORK. <br /> APPROVAL; <br /> 1. PLANNING DI+T� <br /> 2. ENGINEEP.ING __ ' g <br /> TRAPFI : 1 s i0.7 <br /> 6lATER SLiZVICE � � ' <br /> '� SLWER SEP.VICL' v " � <br /> • PUllLIC SEP.VICE SECTIU: <br /> ?. ZNSPF.C'PION DBI'AItTPIE�IT ' <br /> 4. FIRG t•II�RS11�lL � <br /> NOTE: Ai�T� COXETPL'Ci�G:d F;012?: SfI•lLL CO::PLi' l'iI7'i: i�2PLICAL'Li' CODES � IdOTZ.'S <br /> ON Drr1I•77::('S , • •,P I!.Si'EC=_O:i� <br />