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czrY oF �v*�rrr <br />➢UILDINO PLO T I'LA'i <br />Lot N�. �,� ���C � Blk. N•. Zone ?lo. L�t Size x <br />/ �/ Street <br />Additi�n b, a- �� �-«l'. . �� �e_.ti. s� ���1�-�:� '7'-/ �2 �f ��- n�.�,_� Avent:e <br />Unplat,ed Description , <br />/i,l�(,;i.c, �� �ur.(�•i--„r,�r <br />, � <br />Siae of Auilding i¢ x .:'f Hei�ht in Stories �.�� •� (t <br />1 ' <br />Basement �!-„ Occupancy �� <br />Owner r,�,cl, �1�:<<rfr( Contractor ;ry��( !.',:•r7 • E�•.�'l� (l�cNFeL <br />_ <br />Date ? - ? � - E i Permi.t No. — .1� `G <br />Remarks <br />I �' - <br />_ , <br />Signature ii� � C� � �'T . ;, i., <br />n,.,,, e, <br />