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ci1�� o; i;vr;m.r�r ret:r�iz� r�o. /��� � <br /> nt:��,t!;i;n:trr or cn:�a;ir.r��� nrvet.o.PAUiNT . �f /'"�� <br /> . 1fU1Ll)].i;G 1'lilull7.' APl'I.1(:A'CIO.�' VA1.tIATION ��D� ot� <br /> Pf•.Itt•11T F1iE —�— <br /> �BATIi � /, -� <br /> . (j� CQ-ey�c,.-�6n, ����. C>.�...,c� <br /> . � nnn;trss or cotis�rucTmt� t•;oi;t: � � "—�— ••�,�,��,v, �l '��� <br /> LEGAL llESCRIPTIO\: LOT �_ IIi.00K PLATO"1av ,��-c �`� 1,�'�. <br /> UNPI.A[TEU DGSCRIYTIOH: <br /> i . <br /> � . <br /> � . . REPlODL•'L i � . <br /> DUILDI�G llGSGRIPT70\: PIh'td ADllITI0:1 o'r RCPAIIt � + '� ' ` <br /> OCCIIPANCY OR USG • }IEICFITS Iti STORILS <br /> IS T11IS A CIIAI�CC OP IIUILDIt:G OCCUPA1iCY: YES NO �-� � <br /> CO�TPJICTOR '�f�//�-P,t_,_�: `�i'.-ra?`�. — Oj1NER /// /� C' ..����_ <br /> � MAILIi�G f1AILItiG <br /> ADDRI;SS ��� G �� ' ,_ ADDitESS �,��,�,_ (A'�.�.._�e,..�, ��— <br /> ����� � �! ' �i��i� G�,�17�� . <br /> P110RL' 1,'U?�iER a fT 7��n—f 1�/.� PHOPIE 'ttU•[3ER <br /> C0ITRACTOR�S LIC1itiSE fiUiII3ER � :Z � — C I— ��/�C��� <br /> . ) /� J> � • . , <br /> SIGNATURL•' C �.(/ �///�� • !�/`(���_ <br /> NOTC: TI16 APPLICA;:T S11k1.L FILL IN ALL /.P,OI�G BL4t::: C0:•�LETCI.Y It�CLUDIT�C T}Ui PLOT Pi1i� <br /> SY.C9'Cll O:i RL'AR OI•' 'f11Ii uI1LE'f. Tl1E APPLICl�^:T IS RI:5PO��SIRI.E TOi ALL IYFO'r`.iL�fIOiv' I�IIICII <br /> IS PUP.P:ISI16ll OII Tilli A?PT,IC:11'I021. ANY CIL•'.i:CES Iti Tli'� Ii�FO'.:S:�7IO:d, PLOT Pl �': OR EUTI.DIi�C <br /> PLMS SIIALL BG SUEi1IT:ED 'f0 T1lC INSYECTI0:7 DIVISIO�: SOi: AYPROVe\L B�1� ��'�DI��G <br /> NITII TIIG CO\STE:UCTION IJORI:. • . ' <br /> APFl;OY�4L: � . . � <br /> r <br /> � 1. PU+TiNINC. � DATC <br /> 2, F.RC1N1iEI;IICG � <br /> 1RAPPIC DI1'ISIUIJ <br /> � 1dATliR SI:I:VICL•' <br /> . SGF1l:1: S1:RVIC6 ' <br /> PUBLIC SI:R1'ICE SIiCT10:1 <br /> 3. INSYGCTIO�d AL'PAf;TARiNT <br /> . � <br /> 4. FIIt� IIAIt:;f1�1T. ' <br /> NOTIi: AT.L C01J57'I:UCi'IOt: l�!(�Cl: ;11AT.L CO?tl'I.Y 4!I'fll Al'i'I.r.cnr,�'s COlSIiS� hOTL•'S Oi: DI�JdINCS, A�JI> <br /> IR:t1'lit:7'I0;:5 . � <br />