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CITY OF EVI'IRE17 <br />uR,'AI:TTIEMT OF CMAINITY DEVELOPMENT <br />BUILDING PERMIT APPLICAI'10N <br />PERMIT P.O. <br />VALUATION_ a o a = <br />PERMIT 1'EL' rJ 3 cs<m <br />DATE ! '- J " -7j 2 � <br />ADDRESS OF CONSTUCTION WORK ✓� O �e i��� Cy �c��C� <br />LEGAL D17SCRIPTI.ON: LOT .2.i'1 G BLOCK f� PLA'P 4^✓ <br />UNPD%TT'ED DESCRIPTION; <br />BUILDING DESCRIPTION: NEW o.DDITION <br />OCCUPANCY OR USE HEIGHTS IN STORIES - <br />IS TIIIS A.C;IANCE OF B ILDING OCCUPANCY: YES /7 NO Z�n <br />CONTPVXTORGM�� OWNER _ C—i v Cfi Uci l <br />MAILING MAILING <br />ADDRESS //� 3 o SIS� ADDRESS <br />�ve— 0_3 _ <br />PHO;ZE MIMER. •3 3 -7 - PHONE N}Tif.1•ER <br />CONTRACTOR'S LICENSE likinum <br />SIGNATURE C' <br />' .:Z- -7-3— 0 i— 6 �p <br />i•?011lL q�. EPAIR <br />NOTE: THE APPLICANT SI:ALL PILL IN�ALL ABOVE DLf,I.:S CO?II'LETELY INCLUDING Till' PLOT PIAN <br />SKETCH ON REAR OF TIIIS SHEET. THE APPLICANT IS RESPONSIBLE FOR ALL INFOE'iL%TION U1IICH <br />IS FUP.i:I, LIED ON TIllE API LICA'i'IUN. ANY C11AITCES IN THE I TOR:•1ATION, PLOT PM:N OR DUILDING <br />PLANS SHALL BE SUL:dITT1;D TO ME INSPECTION DIVISION FOR APPROVAL BEFORE PR OCEEDIN3 <br />I4ITII THE CONSTRUCTION <br />APPROVAL: <br />1. PLANNING. DATE <br />2. IENCINEERING <br />TRAFFIC DIVISION <br />WATER SERVICE <br />SEWER SERVICE <br />PUBLIC SERVICE SECTION <br />3. INSPECTION DEPART19-M <br />4. FIRE MARSHAL <br />NOTE: ALL CONSTRUCTION WORK SUALL COAPLY WITH APPLICABLE•' CODES, NOTES ON DRAWINGS, AND <br />INSPECTIONS <br />