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Cl'1'Y Uh' EVERj;Tm <br /> 9 UIT, DINQ PLOT FLA P! <br /> Ss�� .� i�o/ <br /> Lot No._/ _� Elk. N�. Zcn= ilo, L�t Size �y X �d� � <br /> Addition ,�e.,w� .,.�µ, , _ � Lr�� , / ¢/,� Street <br /> '7 `T 'b`.�.e���-�'-�-+-�- ��Avenue <br /> Unplattzd Description <br /> Size of Build�ng ��v r�. �' / <br /> Height in Stories <br /> Basement ' I ` Occu anc <br /> ---�_ P Y �„$!@F(p_..�Caa�r. dLl� �_p Q � y . <br /> O�n3er i,�i//dwf �. .CzY'lrr,o Contractor �/�,C��` /�„�/,�lo� T�/c <br /> Date �•l�tr��, ��; �i%� z � � . - <br /> Permit iJo. � /�,� � J �, <br /> � <br /> - -- �CS'� I <br /> � ------- — ' <br /> I ' <br /> I <br /> ♦ � <br /> �J. �u' <br /> (� �J� <br /> . ��F I <br /> n ^o I <br /> � ; <br /> � <br /> , � i i <br /> ; ; <br /> N • I��� <br /> �ont <br /> Remarks <br /> Signature • �'/�S� �u�-�cti �C' , <br /> ������ <br /> ---� <br /> _� _. <br />