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CIT} OP PV�R�TT <br />- DtiPAP.T!d1;L�7` OI' COi•1CdU11I'PY DEV3',LO°;dENT <br />llUILDIIdG 1?Jilu�lIT tll'L'LICliIO;: <br />DI�TE S � � %' 7 � <br />�Vb <br />ADDRESS OP CONSTRUCTION 470RK � <br />LEGAL DESCRIPTION: LOT <br />• UNPLATTED D�SCRIPT1Ci'i S��.r L� <br />i <br />PL•'Iuti1IT NO. 3 %C� <br />/ � �Vi�.LUATIOc: % `J.P� <br />YE1:;4IT FEE S7, ca <br />'I5L L � ��� L.E� � <br />IILOCK P�T <br />/, <br />REDIODEL TEND/VT <br />BUILDING DESCRIPTION: NE�� ADDITION OR REPAIR�i�P%�/� � <br />'�' OF UNITS ( OCCUPA.\CY OR US� � STORIES GYV�_ <br />2Et'>5/G S�tfS <br />` IS THIS A CHANGE OF BUILDING <br />OCCUPANCY: YES N� � <br />CUNTRACTOR �1C/c Co�vST• C�U • <br />i+ll�ILI.iG 72 <br />ADDRESS ��n /��• �S <br />-�'�' /-'QTTL�- if /b 3 <br />PHONE NUbIBER ����' ISJ�ZJ __ <br />0�7N�R /"J/`� ��ICJ �EII. C.O . u <br />I•iIILING' � �y <br />ADDRESS �Ei'.i�i�/T/�-...$ �u�l�. _/03/ <br />� �� �w 9�/0/ <br />PY.ONE NUbISER � � �' �7�_ <br />CONTRACTOR' S LICENSE NUI�iBER Z� �'OI '�% $� <br />SIGNATURE <br />NOTE: THE APPLICANT SHALL FILL I*7 ALL ABOVE IIIF1Ni:5 CO'.•IPL�TELY 1'idCLUDING <br />TIIE PLOT ?',�.'`-.^I SK�TCii ON _Tt�=1P. OF THIS SIiEET. TI?E APPLICA?'T IS RESPOiQSIBLE <br />POR i�LL II:?'OP.e_�TIOi� P:iiICH IS FliRVISHED OiQ THE AYPLICATION. ANY CHANGES <br />IN THE INFORi�i?�iIOti, PLO^_ PL?1i� OR SUILDTNG PLANS SHALL 3E SUBMITTED,^10 TI:E <br />INSPBCTION DTVISIO;� POR APPROVAL BErORE PROC�EDING [^7ITH THE �r��UCTION <br />WORK. / <br />APPROVr�L: <br />1. PLANNInG �/��' ��� <br />ENGINEERING <br />TYi:P'I'IC DIVISZOI4 <br />P7ATER SERVICE <br />S�A'ER SEF.VSCE <br />PUBLIC SEP.VIC� SECTIO^ <br />INSYP:CIION/ DEPARTPIE_]T � .C.eib � � <br />/ - CC/��%'•w <br />—� '�',a..._ c?c... . /.�. _ -' n�..�.., <br />. �., ; <br />FIR� I•IiIRSIIt?L <br />DATE <br />�=F�..�' 1 � — <br />,�- -� � �-r �-/ <br />--�, Z� --� �— <br />NOTE: ALL CONSTP.DC'i'ION Y:OP.?i S:IlLL COt•iPLY jQITII I�PPLICABLE CODFS � IdOT1'S <br />ON DP11P�I:vG.Si, AND I?�SPHCTIOi:S <br />