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H <br />CITY OF liVERI:TT <br />DL'PAI2TI•1I�NT OP COD1I•7UNITY DEVELOPPiIiNT <br />3UILD]:NG PEI2P9I'P APPLICA7'ION <br />f►Ja1�9� <br />r��i�r No. / <br />VALIln1'ION .y, ��� ����/ <br />PERIdIT FE� <br />ADDRESS OF CONSTRUCTION ItiORK a) �Q ' tti�lYC�� _ � <br />LEGAL DESCRIPTION: LOT 2 j y Z� BLUCIC �'v�l�(', <br />UN"LnT'*liD DESCRIPTION <br />PLAT <br />IIUILDII�G DESCRIPTION: NB�9 ADDITION REMOD�L�� <br />— OR REP7�IR <br /># OF UNITS <br />OCCUPANCY OR USE <br />IS TIiIS A CHI�NGE OP Bi7ILDING OCCUPANCY: YES <br />CONTRI�CTOR ,�C��-:�� � � i—�?« ._h +._ <br />tdAILING `� <br />IiDDRESS </�C�/� �cm�vu.�"v ��(� �'-G � <br />��� �,,/ / �% r�,�-O . <br />Lil/a(,�( . IiUi+ti. i d � <br />PH014P NU6IBER ��j � — �� �� <br />CONTRACTOR'S <br />SIGNnTUR� <br />STOFIES <br />NO <br />� <br />Oi�NER .�u,3.t �.�G�-�41ti� 0'��. <br />MASLIN� �" � <br />ADDRliSS d 3 U`✓.✓Ltc�r. C�G �:�;�y <br />PIiON� NUMBER <br />2 - <br />NOTP: THr APPLICANT 513ALL L'ILL IN I�L�OVP DLI�NICS COMPLET�LY INCLUDING <br />TIiE PLOT PLAN SKETCI9 ON RliAR OI' THIS SSiELT. T1iE APPLICANT IS RESPONSIIILE <br />FOR ALL INPORI�TION WIIICH IS PURNI.i13ED ON THE APPLICATION. ANY CHANG�S <br />IN TI3E INI'ORh9ATION, PLOT PLAN OR I3UILDING PLANS SI�ALL IIE SUIIMZTT�D TO 'PIIli <br />INSPECTION DIVISION POR APPI�VAL BEFORE PROCE�DING �9ITII THE C 'PRUCTIOtd <br />WORK. � <br />i <br />APPROVAL: /.,.i f_�__. <br />/ <br />1. PLANNING <br />2. E14G:CNEERING <br />TRI�FFIC DNISION <br />WATLR S1iI2VICE <br />S�WER SL•'RVIC� <br />PUIILIC S�RVIC� SliCTION <br />_'.. INSPSCTION DEI'ARTMGNT <br />4. PIP.r M11RSI�nL <br />DATE <br />NOTP: ALL CONSTRUCTZON i90R]C SifALL COAIPLY l9ITII APPLICI�I3LE CODliS, NOTLS <br />ON DRAI9INGS, AND INSPI:Cl'7:OWS <br />