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i <br />0 <br />v <br />CI'PX Oi' s<\'1_:R��TT <br />nEPRP,Tbll;ti7` OP CO�i:�lUF]I'PY DLVT•.LOPMENT <br />j}UII,UIIIG PJ3i�,IT i�i'PLSCi,TIO:v <br />DIiTE "� �' .� �Jt�� <br />l . r� ) <br />1. ' l' <br />f , , <br />:.�;'�, t! ��;".i..;'i:: <br />P�RMIT NO. � � �i 7 S <br />7'�y�VALUATION , ..SO�S � <br />PEIL�IIT PLr; ' j{' � <br />--� �^ � <br />ADDRESS OF CONSTRUCTION WORK �l CS .20 ti-'t-! �EY_-L i`I ,-r), _ <br />LEGAL DrSCRIPTI0:1: LOT � IILOCK � P�T . �i . ' ' ' <br />/ � . r <br />UNPLATTED DESCRIPTION %�/'/' %�Gi � /� f�c:' .%�� �'`• •• •.'•_ <br />BUILDING DESCRIPTIOA7: NESV ADDITION REAiODEL '/ <br />OR REPAIR x <br />$' OP' tiNITS � OCCUPi�\CY OR USE ^� l<,:'�' ,`�''.''.' � STORIES / <br />IS THIS A CHANGE OF BUILDING OCCUPANCY <br />, <br />CONTRACTOR �L��7'i._' �.�E7`o�.e' �L::,',' n ,;, . <br />i+tAILItiG <br />� .: :: �L�. <br />ADDRESS !?,Stti '�� � � <br />i.,..;f % . . � , I , • ,.. � <br />PHONE NU.•.BER <br />G`�.� S. �• . , <br />CONTF2ACTOR' S LICENSE NUb1EER <br />� ` <br />SIGIdATURE �, i'i;'r /% <br />YES <br />NO � <br />OSt*NER ��G/. U� <br />hIAILIIrTG u�7 �C�';t'�''•t% <br />ADDRESS S"='�`=� .'%Y/:-< <br />� � - :' , %�/C <br />PHONE NUt•iBER `1� L —/< < :�' <br />ry e n ,.. <br />G-4J �'r>/�-Ci.,C�.r_— <br />" i <br />,.4 • �;. ..- : c� � — <br />NOTE: THE APPLICANT SHALL FILL Itd ALL ABOVE III�11IvTiCFi COAiFL�TELY INCLUDING <br />TI�E FLOT ?L::; S'f.EiCH O:i R�IR OF THIS S}iEET. TIIE APPLICF�NT IS RLSPOIQSIBLE <br />FOR ALL Ii:l'C9.iL`.TIC:d S':AICIi IS FUR:dISf]^D GN TIIE APPLICATIOid. ANY CHANGi�S <br />IN Tf]E INFOFidAiIO^:, PLOT PLAN OR BUILDING PLANS SHALL BE SUBMITTED TO 'i:IL <br />I'9SPECTIOi4 DIVISIO:? :'OR APPROVAL BEFOR� PROCEEDIL:G S9ITH THE CONSTRUC`1I021 <br />WORK. . G�/��], � <br />G<�� <br />APP£.OV��L: <br />1 <br />2 <br />PL2INNING <br />ENGIi�i:�F.ING <br />TR7�rFIC DIV1FiI0'i1 <br />T9i�TliR S�RVICli <br />S�WER SEP.VIC� <br />PUIILIC S�P.VICE SECTION <br />INSPECTION DEPARTP1Ei]T ,[✓,//l..Pn � ��� <br />4. FIRE I�itIRSFIAL <br />DATE <br />,�-z5 �? 5. - <br />NOTE: ALI, CONSTRUCiIOY�l �ti0i:h SII.'1LL CO:�IPLY S•;ITII APPI,ICABLE CODL•'S, D!OTES <br />ON DR�S9ItvGS, A":D I?ISPEC'PIO;dS <br />s� : <br />e <br />