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d . . <br /> � !� � U � <br /> CI'tY OF F.Vi:R1.TT <br /> PER��IIT NO. � �� i <br /> nr>>�-+r.lca�r.i` Oi7 COi•I[�iU;17TY DL\�IiI,OP;7ENT <br /> V�II�URTIOI. v <br /> IIU71 II7G P!ii�lIT i�FPLICelTIO:� I'EluiIT FL•'E �c� I <br /> llI�TE �— � �— � \ ' <br /> ADDRESS OP CONSTRUCTION WORK 2 2-Z\ ����' �'� � I <br /> LfiGAL DESCF,IPTION: LOT � I 1Z BLOCK � � PI'p'T _---- I <br /> UNPLATTED DESCRZPTIOi� L�/ G� R� c` T �' <br /> L�oi�D � N <+ �o F� LI�,--�� I <br /> s n �. Lo iZil l=t1 1 �v� �oL 3 ��' �'`� ` ' <br /> 1 \ \ � (Z- L. L7l \` � � <br /> 7 _� C 'z'Z, RCca (-'-Dc Ol= S1�o �or� r�t-1 Cv� ��.T � �'�," �Inll,��N. � <br /> REP70DEL v <br /> BUILDING DL'SCRZPTION: NEt4 _ A�DITION pg KEPAIR /� <br /> $ OF UNITS OCCUPi�_:CY OR USE C��= � STORIES 2 , <br /> IS TFSIS A CHANGE OF IIUILDING OCCUPANCY: YES N� ---�� — I, <br /> '� �._L � �' �� 1.. �' y � <br /> CONTRACTOR S �� OS�TNER �-- <br /> i�IAILII�G 2�7AILIIZG ._ <br /> F�DDRESS I�DDRESS IJ= �/ L ti_',�- ' � <br /> • w h.'�: �-} g�Z.v � <br /> Zsz - � -, y- o <br /> PHONE NU:dBER <br /> PIiONE NUI•iF�ER 34 "' " 4 �'`3`� <br /> CONTRACTOR' S LICEIvSE NUI•IBER <br /> ,{� ? r , <br /> SIGrATURE ?�"�.`�.Q� �--�-3 ` � �,1.�„-a`-v <br /> �NOTH: THE APPLICAIvT SHALL FILL I.7 iiLL AIIOVE BLAI.i�S C0;•SPLETELY INCLUDI\G <br /> 7'IiF. PLOT Pi:::; SI:EiC!I O+ REAR OF T:3IS S}iEET. TII� APPLICF?PP IS RESPONSIIILE <br /> rOR ALL II:iO_T'.:�i:-:'ZO:. T'�2:ICII IS FS:P._1ISHED ON THE P.YPLICATIOi�. AriY CHi'.i�GES <br /> INSPECTIONODIVIS�I0:7 I'OIOtTAPPROVOL BEFGREt,PROCEEDI2cu7Ga[ITH�TIIEIICONSTRUCPIONE <br /> WORX. <br /> I�PP FOV�L: <br /> ' DATE <br /> 1. PLANNING <br /> 2, ENGINEEP.ZNG <br /> T��FFIC DIVISIOi4 <br /> �qATER SERVICE <br /> SEj•]T•.R SERVICli <br /> PUI3LIC SEP.VICL'' SECTIOi7 _ — <br /> ?. INSPECTION D�PART:�1Ef7T ' <br /> Y <br /> �—�—� <br /> — '-�--- <br /> r. riR� r�ni�sn�w <br /> NOTE: ALL CO.:STP.UC'i'T.OId T':OR?: u1iALL CO1iPLY S9I'PII tIPPLIC71IILr CODES� 1dOTI:S <br /> 0�7 DI'vd9INGS, AND I?45PEC'PIOidS <br /> J <br />