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MY OF I'VEUi"I P <br />D1iPARTrIRNT OP C.o:aRINIT; DIM3.01111-MT <br />1rUILVING Munn.' APPLICATION <br />DATE G ' " 7 7 <br />ADDRESS OF CONSTUCTION WORK <br />LE'.AL VZSCRIPTION: LOT <br />BLOCK <br />UNPIATTED DESCRIPTION: <br />PERMIT NO. �f1 <br />VAi.UA1'I0:1 I (7 p �— <br />I'MU-11T FEE o <br />PLAT.—�.�,,•.,! (✓ '.- <br />BUILDING DESCBIPI'ION: NE1.1 e ! J-REIIODEL <br />DDITION fir;+ or REPAIR <br />OCCUPANCY OR USE t: IUiIGHTS Ill STORIES <br />IS THIS A CHANGE OF BUILDING OCCUPANCY: <br />CONTRACTOR <br />HAILING <br />ADDIIESS <br />PHONE KU BER <br />CONI'MCTOR'S ICI:r!SE ;UrGIER <br />SIGNATURG_ <br />YES / NO <br />j <br />01lNER _.r/��e.c. r/Q7ltry(ivl <br />HAILING G <br />ADDRESS O U I y `.3„`i ✓ �,, .� <br />PHONE •NIT.•IBER 3 ti jam y�O <br />NOTE: THE APPLIC !T 51if,LL FILL IN ALL ABOVE DIAI CS COMPLETELY INCLUDIIIG THE PLOT PLAN <br />SKETCH ON REAR OF THIS SKEET, - THE APPLIC." T IS IUiSPO:lSIBLE FOR ALL IKFO*2SV.TIOl1 VIIIC1I <br />IS FURNISHED ON THE APPLICAT'IO:I, ANY C!L'.;;CCS IN T!i i I\FOR 1TIOa, PLOT PL�iI OR EUTI,DIi;C <br />PLANS SHALL BE •UCTIIN WO K. TILE I1lSPECT'IO.' DIVISIO FOR APPROVAL BEFORE PROCEEDING' <br />WITH 1'lIE CONSTRUCTION 1•lOF1:, <br />APPROML: <br />1. PLANNING. <br />DATE <br />2. T•,NCINEERING <br />TRAFFIC DIVISION <br />i I?ATFR St:fiV:ICL' <br />SL'IMR ShIVICE <br />PUBLIC ST:R\'ICF, SECTIOrI <br />3. INSPECTIO' EPARTI-LENT U <br />4. FIRE NARS1IAL <br />NOTE: ALL CONSTRUCTION WOI:K SHALL COMPLY WITH Al'1'LICAIILE CODiiS, MOTES ONDIVd1INCS, Ailll <br />INSI'JiCTIONS <br />