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n <br /> Cl'P� Ol� EVI:RI:TT • P�RtdIT N0. /���f-3 <br /> �EPAY.T:•1EN'1' QL•' C091nIIl1uZ'PY DEVF.LOPMENT <br /> IIUILDII7G PliRitI'f i�l'PLICi:i'IO:. V7ILUATION ^t ��\ ,r��''�.Cc <br /> �. � PElu�7IT Fi;E , ' 9��,� <br /> DATB `iS-.� � �\'��, -Z <br /> � <br /> ADDRESS OF CONSTRUCTION �•70RK , ` ��\` �� n��-`3� ��1`.'�� - <br /> LEGAL DESCRIPTION: LOT �\- �� BLOCK �1��,`i PLIiT C VEt�F� '` <br /> UNPLATTED DBSCRIPTION <br /> i <br /> BUILDING DESCRZPTION: NES9 ADDI^1ION RE6fODEL �� <br /> OR REPAIR <br /> # OP UNITS OCCUPI�:�CY OR USE ,��i�N��- �`)�ci,�_. STOFIES �`�-` <br /> IS THIS A CHAhGE OF BUILDING OCCUPANCY: Y�S NO � <br /> � ^`--'-- <br /> CONTItACTOR �,i��1FCC�ri �U�ti\C���� OWN�R �CC�� �''Hi�\i��-1i1� ��OC'. ��� <br /> ADDR�SS �\�..\lt� b�`, ADDRESS �^,��-� V:;F�h\�1ti�__ ��r_- <br /> �= ���Iti�_�� �,�L�i �-vC-�v�v,'��-v ��,tV`�11 � <br /> PHONE NUDiBER �������- ���, '�� PHON� NUhSBER ���'� ��,1` <br /> � .-_. ,� , �` <br /> CONTRACTOR' S LICENSE\ NUTIBER %�^ � ��- ? ��� <br /> SIGNATURE � ���t- � ,�o;���:',' <br /> NOTli: THE i1PPLICANT St1ALL FILL Iid ALL ABOVE BLAtdKS CO,•IPLrTELY II�CLUDI?:G <br /> Tlf� PLOT PLe'.:v SK�TCII Oi7� RrAR OF THIS SHCBT. T3iE APPLICA�IT IS RESPOi�SILLE <br /> POR LLL INFOR:L•',TIOi7 P]Ii2CII IS FURt:ISHED ON THE APPLICATION. ANY CIiANGES <br /> IN Tf1L INI'ORidAiIO\, PLOT PLAN OR BUILDING P:�ANS SHALL BE SUBi9ITTED TO T::E <br /> INSYECTIOPI DIV25I0:� POR APPROVAL REr^OI:E PROCEEDIT:G i9ITH TI�E CONSTRUCTIO>I <br /> WORR. <br /> hPPROVt?L: - <br /> ,�.;,, . <br /> i';'' 1. PLAIQNING DAT� <br /> 2. ENGIiuT�P.ING <br /> TRAl'F1C DIVI510i1 <br /> P;7�TL•'R SP•.RVICL <br /> SEWER SERVICB <br /> PUIILIC S�RVICE S�CTIOC7 <br /> ,'•. INSP�CTION DEPARTh1ENT // � -9 /�i�I �- <br /> // � <br /> � , 9. PIR� t•ie1F5iL1L ' <br /> NOTIi: ALL CONSTP.UCTIQid l'�012:: 511.1LL CO']['T� SII'I'II 7�PP],IC:I?3LI; CODL'S , b107'L,:; <br /> ON llIU�PtIt1GS, ANb INSPIiC'PTOf]S <br />