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CJ.'11' OF 'All :IIIa"1' <br />hlil',11CI;11':;T 01' C UIUNITY IMM.- .01MENT <br />IiUIi.UL';c; PVIU•I1T APPLICATIOV <br />DA.rli <br />ADDRESS OF CONSIUCTION VOIIK / 9. <br />LTNUUT NO. <br />VALUATION 7117fc <br />Pf•.iU-I1T Flit <br />%KCAL DESCRIPTION: LOT _ 2 BLOCK �p1,/,1 <br />UNPIATTcD DESCRI"', <br />BUILDING DESCRiPTI.ON: 1,11.1 ADDITION ? �L <br />cr REPAIR <br />OCCUPANCY OR USE UrICHTS III STORIES _ <br />IS THIS A CHANGE OF BUILDING OCCUPANCY: YES NO <br />CONTMCTOR _S�.s�ir /S/TMe� <br />HAILING �Y'01•INER <br />ADDRESS r' ��d'SOiL 1fAILING /R� i' <br />ADDRESS f /Z / �' V G ( r /i ' /T v <br />PHOIc LlT•BiER— 92%�" PHOilE'Y.fT.•IrER <br />CONSTRUCTOR'S LICENSE :1111BER <br />SIGNATURE Q r.� — <br />NOTE: THE APPLIC.,,'T SULL FILL IN ALL ADOI'r DLJMS CO',VLETELY INCLUDING THE PLOT PIAN. SKETCH O:i RL%V OF TIiI3 SHEET. - THE APPLI.CA:IT IS I11;SPO::SIBLE FOR ALL ItTO,'!V l'IOI? IMICH <br />IS PUMNISHED CIN THE APPLIC..T'IO?]. ANY CiLl.:;CES Itl TH3 INFC?d A710:1, PLOT PLU OR EUII.L,ii:G <br />PLtuIS SIJALL BE SUli:•iITZED TO THE INSPSCTI011 DIVISIO:t FOP. APPROVAL BEFORE PROCEEDING <br />WITH THE CONSTP.UCTION WOrK. . <br />APPROVAL . <br />1, PIhIINIKG. <br />DATE <br />2, HomcEPING <br />TRAPI'IC DIVISIOi4 <br />i L'ATI'R SIiRVICE <br />SLHL•'1: S1:RVICE <br />PUDLIC SERVICE SECT10:1 <br />3. INSPECTION DEPARTHENT <br />4. FIRE MRSHAL <br />H01'I•:: ALL CONSTi:UCTI0:1 h'0J:1: SHALL CO:•IDLY IIITII APPLICAELE C01.1i5 � NOTES ON DIZAIIINCS AND <br />111.10TUTIMS <br />